Grady Health System "Updated April 15,2023" Procedure Code Type Code NDC Procedure Description IP/OP Charge Cash Discount (74%) Payor Rate Min Payor Rate Max Aetna Exp Reimbursement Coventry Exp Reimbursement Aetna Advantage Coventry Advantage Ambetter Exp Reimbursement Amerigroup Exp Reimbursement Anthem BCBS HMO Exp Reimbursement Anthem BCBS POS Exp Reimbursement BCBS PPO Exp Reimbursement BCBS Advantage CareSource CMO Exp Reimbursement CareSource Advantage Exp Reimbursement Cigna Exp Reimbursement Cigna Advantage Eon Health Exp Reimbursement Humana Exp Reimbursement Kaiser Exp Reimbursement Multiplan Exp Reimbursement NaphCare Exp Reimbursement Oscar Exp Reimbursement USP Exp Reimbursement Peachstate Exp Reimbursement Tricare Choice Exp Reimbursement Veteran's Choice Exp Reimbursement Wellcare Medicaid Exp Reimbursement Wellcare Medicare Exp Reimbusrement CIGNA CLOVER MEDICAID SONDER MS003 DRG MS003 "ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES" INPATIENT ONLY "$846,619.47" "$626,498.41" $0.00 "$633,310.40" "$545,963.96" "$545,963.96" "$246,500.86" "$246,500.86" "$226,063.68" $0.00 $0.00 $0.00 "$633,310.40" "$169,544.23" $0.00 "$200,521.93" "$552,556.41" "$552,556.41" "$136,503.65" "$413,995.33" "$504,437.36" "$573,019.79" "$182,532.67" "$552,556.41" "$182,532.67" "$185,417.02" "$167,931.68" "$167,931.68" "$136,503.65" "$194,687.78" $0.00 $0.00 $0.00 $0.00 MS004 DRG MS004 "TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES" INPATIENT ONLY "$560,790.65" "$414,985.08" $0.00 "$500,611.30" "$303,701.56" "$303,701.56" "$102,651.23" "$102,651.23" "$117,598.72" "$139,546.44" $0.00 $0.00 $0.00 "$93,123.67" "$139,546.44" "$106,877.24" "$307,479.91" "$307,479.91" "$112,641.38" "$410,855.25" "$500,611.30" $0.00 "$134,386.24" "$307,479.91" "$134,386.24" "$32,473.86" "$147,233.83" "$147,233.83" "$107,277.50" "$34,561.30" $0.00 $0.00 $0.00 $0.00 MS011 DRG MS011 "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC" INPATIENT ONLY "$341,624.34" "$252,802.01" $0.00 "$53,518.70" $0.00 $0.00 "$45,708.66" "$45,708.66" $0.00 $0.00 $0.00 $0.00 $0.00 "$45,618.98" $0.00 "$46,622.83" $0.00 $0.00 "$47,587.29" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$53,518.70" "$53,518.70" "$45,321.23" $0.00 $0.00 $0.00 $0.00 $0.00 MS012 DRG MS012 "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC" INPATIENT ONLY "$435,854.28" "$322,532.17" $0.00 "$527,844.11" $0.00 $0.00 "$64,752.45" "$64,752.45" $0.00 $0.00 $0.00 $0.00 "$527,844.11" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$112,717.74" "$124,172.81" "$124,172.81" $0.00 "$40,861.37" $0.00 $0.00 $0.00 $0.00 MS013 DRG MS013 "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC" INPATIENT ONLY "$427,041.11" "$316,010.42" $0.00 "$28,929.99" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$28,929.99" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$28,929.99" $0.00 $0.00 $0.00 $0.00 $0.00 MS020 DRG MS020 INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC INPATIENT ONLY "$640,592.00" "$474,038.08" $0.00 "$461,392.05" $0.00 $0.00 "$117,892.75" "$117,892.75" "$130,119.32" $0.00 $0.00 $0.00 "$445,362.06" "$82,209.64" $0.00 "$84,042.11" "$354,069.74" "$354,069.74" "$87,750.60" "$378,667.73" "$461,392.05" $0.00 "$121,357.54" "$354,069.74" "$121,357.54" $0.00 "$101,514.63" "$101,514.63" "$83,572.00" $0.00 $0.00 $0.00 $0.00 $0.00 MS021 DRG MS021 INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC INPATIENT ONLY "$829,388.27" "$613,747.32" $0.00 "$583,001.67" "$432,052.38" "$432,052.38" $0.00 $0.00 "$185,501.54" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$538,738.80" "$538,738.80" $0.00 "$478,473.59" "$583,001.67" $0.00 "$152,156.12" "$538,738.80" "$152,156.12" $0.00 "$91,625.03" "$91,625.03" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS022 DRG MS022 INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC INPATIENT ONLY "$262,016.11" "$193,891.92" $0.00 "$95,010.54" $0.00 $0.00 "$44,476.05" "$44,476.05" $0.00 $0.00 $0.00 $0.00 $0.00 "$88,779.12" $0.00 $0.00 $0.00 $0.00 "$95,010.54" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$38,549.28" $0.00 $0.00 "$90,486.22" "$40,476.72" $0.00 $0.00 $0.00 $0.00 MS023 DRG MS023 CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR INPATIENT ONLY "$218,569.58" "$161,741.49" $0.00 "$201,607.59" "$122,687.67" "$122,687.67" "$50,198.05" "$50,198.05" "$63,817.39" $0.00 $0.00 $0.00 "$44,292.45" "$50,096.77" $0.00 "$67,359.13" "$201,607.59" "$201,607.59" "$52,188.44" "$105,398.91" "$128,424.52" "$123,922.26" "$56,307.53" "$201,607.59" "$56,307.53" "$53,114.71" "$59,017.16" "$59,017.16" "$49,703.28" "$55,770.42" $0.00 $0.00 $0.00 $0.00 MS024 DRG MS024 CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC INPATIENT ONLY "$157,585.04" "$116,612.93" $0.00 "$101,279.86" "$101,279.86" "$101,279.86" "$38,238.47" "$38,238.47" $0.00 $0.00 $0.00 $0.00 "$76,208.16" "$38,168.13" $0.00 "$39,003.24" $0.00 $0.00 "$41,250.33" "$33,522.62" "$79,948.14" "$86,190.36" "$40,262.62" $0.00 "$40,262.62" $0.00 "$45,945.91" "$45,945.91" "$39,286.03" $0.00 $0.00 $0.00 $0.00 $0.00 MS025 DRG MS025 CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC INPATIENT ONLY "$478,309.25" "$353,948.85" $0.00 "$226,592.28" "$226,592.28" "$226,592.28" "$54,020.48" "$54,020.48" $0.00 "$111,176.48" $0.00 $0.00 "$124,468.05" "$42,011.95" "$140,855.50" "$55,104.90" $0.00 $0.00 "$43,833.50" "$153,273.67" "$186,758.08" "$99,788.97" "$44,051.81" $0.00 "$44,051.81" $0.00 "$49,032.85" "$49,032.85" "$41,746.19" $0.00 $0.00 $0.00 $0.00 $0.00 MS026 DRG MS026 CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC INPATIENT ONLY "$270,390.78" "$200,089.18" $0.00 "$374,897.72" "$363,866.18" "$363,866.18" "$32,699.36" "$32,699.36" "$115,593.63" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$33,354.58" "$374,897.72" "$374,897.72" $0.00 $0.00 $0.00 $0.00 $0.00 "$374,897.72" $0.00 $0.00 "$38,018.73" "$38,018.73" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS027 DRG MS027 CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$150,043.04" "$111,031.85" $0.00 "$232,805.15" $0.00 $0.00 "$28,405.90" "$28,405.90" $0.00 "$54,890.22" $0.00 $0.00 $0.00 $0.00 "$69,843.08" "$28,974.02" $0.00 $0.00 "$30,181.04" "$191,064.82" "$232,805.15" "$82,819.30" "$36,977.13" $0.00 "$36,977.13" $0.00 "$32,717.89" "$32,717.89" "$28,743.85" $0.00 $0.00 $0.00 $0.00 $0.00 MS028 DRG MS028 SPINAL PROCEDURES WITH MCC INPATIENT ONLY "$378,830.18" "$280,334.33" $0.00 "$240,380.32" $0.00 $0.00 "$50,062.96" "$50,062.96" "$77,466.83" $0.00 $0.00 $0.00 "$238,773.51" $0.00 $0.00 $0.00 "$240,380.32" "$240,380.32" "$52,005.99" "$141,041.44" "$171,853.56" $0.00 "$56,039.87" "$240,380.32" "$56,039.87" $0.00 "$58,799.12" "$58,799.12" "$49,529.51" $0.00 $0.00 $0.00 $0.00 $0.00 MS029 DRG MS029 SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS INPATIENT ONLY "$255,521.10" "$189,085.61" $0.00 "$229,583.19" $0.00 $0.00 "$33,806.33" "$33,806.33" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$34,482.46" $0.00 $0.00 "$35,718.41" $0.00 $0.00 "$229,583.19" $0.00 $0.00 $0.00 $0.00 "$39,335.16" "$39,335.16" "$34,017.53" $0.00 $0.00 $0.00 $0.00 $0.00 MS030 DRG MS030 SPINAL PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$247,560.24" "$183,194.58" $0.00 "$29,329.56" $0.00 $0.00 $0.00 $0.00 $0.00 "$19,797.75" $0.00 $0.00 $0.00 $0.00 "$19,797.75" $0.00 $0.00 $0.00 "$29,329.56" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$27,932.91" $0.00 $0.00 $0.00 $0.00 $0.00 MS031 DRG MS031 VENTRICULAR SHUNT PROCEDURES WITH MCC INPATIENT ONLY "$411,152.28" "$304,252.69" $0.00 "$59,024.65" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$22,834.72" "$59,024.65" "$59,024.65" $0.00 "$23,976.45" $0.00 $0.00 $0.00 $0.00 MS032 DRG MS032 VENTRICULAR SHUNT PROCEDURES WITH CC INPATIENT ONLY "$213,869.28" "$158,263.27" $0.00 "$14,380.55" "$14,380.55" "$14,380.55" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS033 DRG MS033 VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$184,494.76" "$136,526.12" $0.00 "$12,635.25" "$9,990.32" "$9,990.32" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$12,033.57" $0.00 $0.00 $0.00 "$12,635.25" $0.00 $0.00 $0.00 $0.00 MS034 DRG MS034 CAROTID ARTERY STENT PROCEDURES WITH MCC INPATIENT ONLY "$284,867.36" "$210,801.85" $0.00 "$160,900.01" "$160,900.01" "$160,900.01" "$38,508.31" "$38,508.31" $0.00 $0.00 $0.00 $0.00 $0.00 "$38,437.26" $0.00 "$39,278.48" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$43,799.77" "$43,799.77" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS035 DRG MS035 CAROTID ARTERY STENT PROCEDURES WITH CC INPATIENT ONLY "$129,223.20" "$95,625.17" $0.00 "$31,946.16" $0.00 $0.00 "$27,200.91" "$27,200.91" $0.00 $0.00 $0.00 $0.00 $0.00 "$27,159.12" $0.00 "$27,744.93" $0.00 $0.00 "$29,535.25" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$31,946.16" "$31,946.16" "$28,128.81" $0.00 $0.00 $0.00 $0.00 $0.00 MS036 DRG MS036 CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$63,272.72" "$46,821.81" $0.00 "$9,048.30" "$9,048.30" "$9,048.30" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS037 DRG MS037 EXTRACRANIAL PROCEDURES WITH MCC INPATIENT ONLY "$179,064.31" "$132,507.59" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS038 DRG MS038 EXTRACRANIAL PROCEDURES WITH CC INPATIENT ONLY "$162,863.49" "$120,518.98" $0.00 "$26,825.78" $0.00 $0.00 "$22,501.67" "$22,501.67" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$22,951.70" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$26,825.78" "$26,825.78" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS039 DRG MS039 EXTRACRANIAL PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$99,295.23" "$73,478.47" $0.00 "$53,458.66" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$19,293.26" $0.00 $0.00 $0.00 "$43,873.91" "$53,458.66" $0.00 "$11,340.50" $0.00 "$11,340.50" $0.00 "$22,384.03" "$22,384.03" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS040 DRG MS040 "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC" INPATIENT ONLY "$181,156.10" "$134,055.51" $0.00 "$120,959.00" "$114,037.71" "$114,037.71" "$37,726.38" "$37,726.38" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$38,480.91" $0.00 $0.00 "$40,730.30" "$99,271.90" "$120,959.00" $0.00 "$39,499.78" $0.00 "$39,499.78" "$26,844.41" "$45,324.46" "$45,324.46" "$38,790.76" "$28,186.61" $0.00 $0.00 $0.00 $0.00 MS041 DRG MS041 "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR" INPATIENT ONLY "$127,537.44" "$94,377.71" $0.00 "$72,242.00" "$37,578.12" "$37,578.12" "$27,269.91" "$27,269.91" $0.00 "$27,327.64" $0.00 $0.00 $0.00 "$27,227.95" "$27,327.64" "$27,815.31" $0.00 $0.00 "$30,008.81" "$6,724.57" "$72,242.00" $0.00 "$23,772.63" $0.00 "$23,772.63" "$26,156.21" "$32,512.09" "$32,512.09" "$28,579.82" "$27,464.00" $0.00 $0.00 $0.00 $0.00 MS042 DRG MS042 "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC" INPATIENT ONLY "$105,060.67" "$77,744.90" $0.00 "$125,934.52" "$18,514.80" "$18,514.80" "$24,174.58" "$24,174.58" "$16,589.36" "$107,683.75" $0.00 $0.00 $0.00 $0.00 "$107,684.43" "$24,658.07" "$67,315.38" "$67,315.38" $0.00 $0.00 $0.00 "$125,934.52" $0.00 "$67,315.38" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS052 DRG MS052 SPINAL DISORDERS AND INJURIES WITH CC/MCC INPATIENT ONLY "$156,658.67" "$115,927.42" $0.00 "$83,265.35" $0.00 $0.00 "$23,845.39" "$23,845.39" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$24,322.30" $0.00 $0.00 "$24,934.09" "$68,336.46" "$83,265.35" $0.00 "$16,328.58" $0.00 "$16,328.58" $0.00 "$26,447.68" "$26,447.68" "$23,746.75" $0.00 $0.00 $0.00 $0.00 $0.00 MS053 DRG MS053 SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC INPATIENT ONLY "$178,803.45" "$132,314.55" $0.00 "$18,896.33" $0.00 $0.00 "$18,896.33" "$18,896.33" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS054 DRG MS054 NERVOUS SYSTEM NEOPLASMS WITH MCC INPATIENT ONLY "$57,218.00" "$42,341.32" $0.00 "$32,180.45" "$28,652.18" "$28,652.18" "$20,496.79" "$20,496.79" "$11,646.29" $0.00 $0.00 $0.00 $0.00 "$20,472.36" $0.00 "$20,906.73" "$20,524.50" "$20,524.50" "$22,960.49" "$15,497.86" "$32,180.45" $0.00 "$13,433.57" "$20,524.50" "$13,433.57" "$16,209.33" "$24,089.19" "$24,089.19" "$21,867.13" "$16,209.33" $0.00 $0.00 $0.00 $0.00 MS055 DRG MS055 NERVOUS SYSTEM NEOPLASMS WITHOUT MCC INPATIENT ONLY "$29,991.33" "$22,193.58" $0.00 "$20,540.66" "$12,259.80" "$12,259.80" "$18,262.77" "$18,262.77" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$18,628.03" $0.00 $0.00 "$20,540.66" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$12,303.42" $0.00 $0.00 "$19,562.53" "$12,918.59" $0.00 $0.00 $0.00 $0.00 MS056 DRG MS056 DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC INPATIENT ONLY "$74,193.16" "$54,902.94" $0.00 "$32,929.50" "$12,532.35" "$12,532.35" "$26,204.32" "$26,204.32" "$15,722.67" "$27,637.01" $0.00 $0.00 "$16,742.05" "$26,165.12" "$27,637.01" "$26,728.41" "$32,929.50" "$32,929.50" "$28,784.91" $0.00 $0.00 $0.00 $0.00 "$32,929.50" $0.00 "$3,891.53" "$31,049.49" "$31,049.49" "$27,414.20" "$4,141.69" $0.00 $0.00 $0.00 $0.00 MS057 DRG MS057 DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC INPATIENT ONLY "$48,700.14" "$36,038.10" $0.00 "$24,142.42" "$24,142.42" "$24,142.42" "$19,801.12" "$19,801.12" "$9,014.09" $0.00 $0.00 $0.00 $0.00 "$19,778.49" $0.00 "$20,197.14" "$19,012.50" "$19,012.50" "$20,335.16" "$9,564.24" "$17,411.42" $0.00 "$12,137.42" "$19,012.50" "$12,137.42" $0.00 "$18,349.35" "$18,349.35" "$19,366.82" $0.00 $0.00 $0.00 $0.00 $0.00 MS058 DRG MS058 MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC INPATIENT ONLY "$57,255.06" "$42,368.74" $0.00 "$35,850.39" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$8,006.13" "$27,593.07" $0.00 "$19,594.52" $0.00 "$19,594.52" $0.00 "$35,850.39" "$35,850.39" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS059 DRG MS059 MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC INPATIENT ONLY "$42,378.53" "$31,360.11" $0.00 "$63,687.23" "$63,687.23" "$63,687.23" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$3,348.41" $0.00 $0.00 $0.00 $0.00 $0.00 "$21,254.77" "$16,079.42" "$33,948.36" $0.00 "$10,931.50" $0.00 "$10,931.50" $0.00 "$22,050.83" "$22,050.83" "$20,242.64" $0.00 $0.00 $0.00 $0.00 $0.00 MS060 DRG MS060 MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC INPATIENT ONLY "$17,859.37" "$13,215.93" $0.00 "$17,386.96" $0.00 $0.00 "$17,386.96" "$17,386.96" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS061 DRG MS061 "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC" INPATIENT ONLY "$95,693.84" "$70,813.44" $0.00 "$215,011.32" "$92,084.48" "$92,084.48" "$31,007.07" "$31,007.07" $0.00 $0.00 $0.00 $0.00 $0.00 "$30,955.43" $0.00 "$31,627.21" $0.00 $0.00 "$32,892.67" "$176,461.31" "$215,011.32" $0.00 "$32,518.99" $0.00 "$32,518.99" $0.00 "$35,958.33" "$35,958.33" "$31,326.35" $0.00 $0.00 $0.00 $0.00 $0.00 MS062 DRG MS062 "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC" INPATIENT ONLY "$103,906.20" "$76,890.59" $0.00 "$73,869.50" "$19,584.47" "$19,584.47" "$24,775.73" "$24,775.73" "$16,561.69" $0.00 $0.00 $0.00 $0.00 "$24,740.22" $0.00 "$25,271.24" "$29,824.50" "$29,824.50" "$27,546.62" "$15,607.97" "$73,869.50" $0.00 "$20,160.87" "$29,824.50" "$20,160.87" $0.00 "$29,569.72" "$29,569.72" "$26,234.88" $0.00 $0.00 $0.00 $0.00 $0.00 MS063 DRG MS063 "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC" INPATIENT ONLY "$95,685.66" "$70,807.39" $0.00 "$50,374.27" "$8,398.95" "$8,398.95" "$22,852.96" "$22,852.96" "$13,476.07" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$23,310.02" "$25,645.50" "$25,645.50" $0.00 "$18,358.07" "$50,374.27" $0.00 "$16,848.86" "$25,645.50" "$16,848.86" $0.00 "$26,871.51" "$26,871.51" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS064 DRG MS064 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC INPATIENT ONLY "$123,857.52" "$91,654.56" $0.00 "$110,327.78" "$110,327.78" "$110,327.78" "$25,320.78" "$25,320.78" "$15,513.81" "$25,409.92" $0.00 $0.00 "$17,959.97" "$25,286.52" "$25,409.92" "$24,782.69" "$28,783.50" "$28,783.50" "$26,614.49" "$27,643.93" "$64,405.47" $0.00 "$18,793.56" "$28,783.50" "$18,793.56" "$44,500.15" "$28,455.79" "$28,455.79" "$25,347.13" "$25,793.36" $0.00 $0.00 $0.00 $0.00 MS065 DRG MS065 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS INPATIENT ONLY "$79,103.20" "$58,536.37" $0.00 "$60,123.35" "$27,569.45" "$27,569.45" "$18,093.01" "$18,093.01" "$9,499.65" "$13,734.30" $0.00 $0.00 "$6,993.69" "$18,074.80" "$13,734.30" "$18,454.87" "$15,300.00" "$15,300.00" "$20,825.64" "$15,153.44" "$60,123.35" "$54,112.55" "$10,301.98" "$15,300.00" "$10,301.98" $0.00 "$21,537.99" "$21,537.99" "$19,833.94" $0.00 $0.00 $0.00 $0.00 $0.00 MS066 DRG MS066 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC INPATIENT ONLY "$41,730.17" "$30,880.33" $0.00 "$30,837.84" $0.00 $0.00 "$15,964.58" "$15,964.58" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$16,283.87" $0.00 $0.00 "$18,702.38" "$8,810.14" "$30,837.84" $0.00 "$7,187.44" $0.00 "$7,187.44" $0.00 "$19,000.67" "$19,000.67" "$17,811.79" $0.00 $0.00 $0.00 $0.00 $0.00 MS067 DRG MS067 NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC INPATIENT ONLY "$113,443.89" "$83,948.48" $0.00 "$25,105.11" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$25,105.11" "$25,105.11" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS068 DRG MS068 NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC INPATIENT ONLY "$68,653.56" "$50,803.63" $0.00 "$20,522.91" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$19,976.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$20,522.91" "$20,522.91" "$19,024.95" $0.00 $0.00 $0.00 $0.00 $0.00 MS069 DRG MS069 TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC INPATIENT ONLY "$52,701.73" "$38,999.28" $0.00 "$19,517.62" "$4,165.08" "$4,165.08" "$16,485.64" "$16,485.64" $0.00 $0.00 $0.00 $0.00 "$3,348.41" "$16,471.58" $0.00 "$16,815.35" $0.00 $0.00 "$19,134.97" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$19,517.62" "$19,517.62" "$18,223.78" $0.00 $0.00 $0.00 $0.00 $0.00 MS070 DRG MS070 NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC INPATIENT ONLY "$118,539.35" "$87,719.12" $0.00 "$36,315.50" "$16,579.68" "$16,579.68" "$22,645.22" "$22,645.22" "$14,672.11" $0.00 $0.00 $0.00 $0.00 "$36,315.50" $0.00 "$23,098.12" "$25,194.00" "$25,194.00" "$25,234.77" $0.00 $0.00 $0.00 $0.00 "$25,194.00" $0.00 $0.00 "$32,577.11" "$32,577.11" "$28,582.72" $0.00 $0.00 $0.00 $0.00 $0.00 MS071 DRG MS071 NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC INPATIENT ONLY "$54,131.74" "$40,057.49" $0.00 "$35,678.57" "$4,086.60" "$4,086.60" "$18,036.40" "$18,036.40" $0.00 $0.00 $0.00 $0.00 $0.00 "$18,018.34" $0.00 "$18,397.13" $0.00 $0.00 "$20,600.14" $0.00 $0.00 "$35,678.57" $0.00 $0.00 $0.00 $0.00 "$21,268.52" "$21,268.52" "$19,619.18" $0.00 $0.00 $0.00 $0.00 $0.00 MS072 DRG MS072 NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC INPATIENT ONLY "$61,347.12" "$45,396.87" $0.00 "$18,849.31" $0.00 $0.00 "$16,379.34" "$16,379.34" $0.00 $0.00 $0.00 $0.00 $0.00 "$16,365.57" $0.00 "$16,706.93" $0.00 $0.00 "$18,849.31" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$17,951.72" $0.00 $0.00 $0.00 $0.00 $0.00 MS073 DRG MS073 CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC INPATIENT ONLY "$41,000.17" "$30,340.13" $0.00 "$24,705.77" $0.00 $0.00 "$21,080.64" "$21,080.64" $0.00 "$14,136.39" $0.00 $0.00 $0.00 $0.00 "$14,136.39" "$21,502.25" $0.00 $0.00 "$23,476.45" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$24,705.77" "$24,705.77" "$22,358.52" $0.00 $0.00 $0.00 $0.00 $0.00 MS074 DRG MS074 CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC INPATIENT ONLY "$33,436.38" "$24,742.92" $0.00 "$36,882.23" "$25,719.00" "$25,719.00" $0.00 $0.00 $0.00 "$8,974.55" $0.00 $0.00 "$6,696.82" "$18,067.90" "$8,974.55" $0.00 $0.00 $0.00 "$20,555.00" "$14,569.53" "$36,882.23" $0.00 "$9,905.01" $0.00 "$9,905.01" "$8,589.85" "$21,214.59" "$21,214.59" "$19,576.19" "$9,019.34" $0.00 $0.00 $0.00 $0.00 MS075 DRG MS075 VIRAL MENINGITIS WITH CC/MCC INPATIENT ONLY "$63,854.38" "$47,252.24" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS077 DRG MS077 HYPERTENSIVE ENCEPHALOPATHY WITH MCC INPATIENT ONLY "$29,147.98" "$21,569.51" $0.00 "$25,742.09" "$13,255.89" "$13,255.89" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$22,065.43" $0.00 $0.00 "$24,343.64" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$25,742.09" "$25,742.09" "$23,184.42" $0.00 $0.00 $0.00 $0.00 $0.00 MS078 DRG MS078 HYPERTENSIVE ENCEPHALOPATHY WITH CC INPATIENT ONLY "$59,520.47" "$44,045.15" $0.00 "$20,376.67" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$20,376.67" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$19,406.35" $0.00 $0.00 $0.00 $0.00 $0.00 MS080 DRG MS080 NONTRAUMATIC STUPOR AND COMA WITH MCC INPATIENT ONLY "$109,992.22" "$81,394.24" $0.00 "$29,003.98" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$29,003.98" "$29,003.98" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS081 DRG MS081 NONTRAUMATIC STUPOR AND COMA WITHOUT MCC INPATIENT ONLY "$65,998.93" "$48,839.21" $0.00 "$20,324.45" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$20,324.45" "$20,324.45" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS082 DRG MS082 TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC INPATIENT ONLY "$109,243.85" "$80,840.45" $0.00 "$73,345.89" "$12,231.51" "$12,231.51" "$26,677.77" "$26,677.77" "$17,085.63" $0.00 $0.00 $0.00 "$16,934.46" "$26,637.35" $0.00 "$33,757.89" "$33,958.50" "$33,958.50" "$29,190.82" "$60,195.49" "$73,345.89" $0.00 "$22,572.74" "$33,958.50" "$22,572.74" $0.00 "$31,534.56" "$31,534.56" "$27,800.78" $0.00 $0.00 $0.00 $0.00 $0.00 MS083 DRG MS083 TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC INPATIENT ONLY "$91,871.44" "$67,984.87" $0.00 "$83,592.12" "$19,781.66" "$19,781.66" "$20,329.09" "$20,329.09" "$11,068.80" $0.00 $0.00 $0.00 "$16,307.27" "$20,305.08" $0.00 "$20,735.67" "$20,160.00" "$20,160.00" "$22,759.59" "$68,604.63" "$83,592.12" $0.00 "$13,138.85" "$20,160.00" "$13,138.85" $0.00 "$23,849.11" "$23,849.11" "$21,675.80" $0.00 $0.00 $0.00 $0.00 $0.00 MS084 DRG MS084 TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC INPATIENT ONLY "$60,065.16" "$44,448.22" $0.00 "$105,860.74" "$105,860.74" "$105,860.74" "$17,303.46" "$17,303.46" $0.00 $0.00 $0.00 $0.00 "$21,552.95" "$17,287.29" $0.00 "$17,649.53" $0.00 $0.00 "$18,985.24" "$74,022.47" "$90,193.56" $0.00 "$8,994.81" $0.00 "$8,994.81" $0.00 "$20,473.08" "$20,473.08" "$18,985.24" $0.00 $0.00 $0.00 $0.00 $0.00 MS085 DRG MS085 TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC INPATIENT ONLY "$133,066.60" "$98,469.28" $0.00 "$189,335.99" "$129,464.98" "$129,464.98" "$27,007.67" "$27,007.67" $0.00 $0.00 $0.00 $0.00 "$46,184.90" "$26,966.37" $0.00 "$27,547.82" $0.00 $0.00 "$29,149.82" "$155,389.38" "$189,335.99" $0.00 "$23,840.21" $0.00 "$23,840.21" "$6,719.03" "$39,231.69" "$39,231.69" "$27,761.73" "$7,054.97" $0.00 $0.00 $0.00 $0.00 MS086 DRG MS086 TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC INPATIENT ONLY "$91,005.46" "$67,344.04" $0.00 "$156,793.36" "$16,054.95" "$16,054.95" "$19,849.42" "$19,849.42" "$9,979.86" $0.00 $0.00 $0.00 "$39,612.08" "$19,826.66" $0.00 "$20,246.41" "$66,216.14" "$66,216.14" "$22,261.41" "$21,878.17" "$26,657.70" "$156,793.36" "$12,408.08" "$66,216.14" "$12,408.08" $0.00 "$23,253.77" "$23,253.77" "$21,201.34" $0.00 $0.00 $0.00 $0.00 $0.00 MS087 DRG MS087 TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC INPATIENT ONLY "$54,038.57" "$39,988.54" $0.00 "$54,184.31" "$10,442.68" "$10,442.68" "$17,013.59" "$17,013.59" "$6,658.59" "$6,337.82" $0.00 $0.00 "$4,618.49" $0.00 "$6,337.82" "$17,353.86" "$12,954.00" "$12,954.00" "$19,537.48" "$44,469.44" "$54,184.31" $0.00 "$8,412.39" "$12,954.00" "$8,412.39" "$6,066.14" "$19,998.62" "$19,998.62" "$18,607.12" "$6,369.44" $0.00 $0.00 $0.00 $0.00 MS088 DRG MS088 CONCUSSION WITH MCC INPATIENT ONLY "$61,942.49" "$45,837.44" $0.00 "$12,687.93" $0.00 $0.00 $0.00 $0.00 $0.00 "$12,687.93" $0.00 $0.00 $0.00 $0.00 "$12,687.93" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS089 DRG MS089 CONCUSSION WITH CC INPATIENT ONLY "$82,992.64" "$61,414.55" $0.00 "$74,998.20" "$74,998.20" "$74,998.20" "$18,393.22" "$18,393.22" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$18,761.08" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS090 DRG MS090 CONCUSSION WITHOUT CC/MCC INPATIENT ONLY "$63,676.92" "$47,120.92" $0.00 "$19,599.65" $0.00 $0.00 $0.00 $0.00 "$6,563.09" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$12,819.00" "$12,819.00" "$19,599.65" $0.00 $0.00 $0.00 $0.00 "$12,819.00" $0.00 $0.00 $0.00 $0.00 "$18,666.33" $0.00 $0.00 $0.00 $0.00 $0.00 MS091 DRG MS091 OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC INPATIENT ONLY "$52,693.58" "$38,993.25" $0.00 "$26,373.98" $0.00 $0.00 "$26,373.98" "$26,373.98" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$22,895.40" $0.00 $0.00 "$24,498.09" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$25,926.64" "$25,926.64" "$23,331.51" $0.00 $0.00 $0.00 $0.00 $0.00 MS092 DRG MS092 OTHER DISORDERS OF NERVOUS SYSTEM WITH CC INPATIENT ONLY "$112,379.69" "$83,160.97" $0.00 "$60,857.94" "$4,119.13" "$4,119.13" "$17,878.35" "$17,878.35" $0.00 $0.00 $0.00 $0.00 $0.00 "$17,860.69" $0.00 "$18,235.92" $0.00 $0.00 "$20,404.67" "$3,652.60" "$60,857.94" $0.00 "$9,684.47" $0.00 "$9,684.47" $0.00 "$21,034.94" "$21,034.94" "$19,433.02" $0.00 $0.00 $0.00 $0.00 $0.00 MS093 DRG MS093 OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC INPATIENT ONLY "$23,227.89" "$17,188.64" $0.00 "$21,343.61" "$5,791.65" "$5,791.65" "$16,451.82" "$16,451.82" $0.00 "$7,940.48" $0.00 $0.00 $0.00 "$16,437.85" "$7,940.48" "$16,780.86" $0.00 $0.00 "$19,004.44" "$4,008.53" "$21,343.61" $0.00 "$7,630.49" $0.00 "$7,630.49" $0.00 "$19,361.64" "$19,361.64" "$18,099.47" $0.00 $0.00 $0.00 $0.00 $0.00 MS094 DRG MS094 BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC INPATIENT ONLY "$208,527.33" "$154,310.22" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS095 DRG MS095 BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC INPATIENT ONLY "$128,295.60" "$94,938.74" $0.00 "$28,357.59" $0.00 $0.00 "$28,357.59" "$28,357.59" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS097 DRG MS097 NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC INPATIENT ONLY "$40,298.97" "$29,821.24" $0.00 "$141,271.31" "$13,337.55" "$13,337.55" "$37,005.85" "$37,005.85" $0.00 $0.00 $0.00 $0.00 "$141,271.31" "$36,938.70" $0.00 "$37,745.97" $0.00 $0.00 "$38,239.38" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$46,143.44" $0.00 $0.00 $0.00 $0.00 $0.00 MS098 DRG MS098 NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC INPATIENT ONLY "$81,880.42" "$60,591.51" $0.00 "$27,162.57" $0.00 $0.00 "$25,632.89" "$25,632.89" $0.00 $0.00 $0.00 $0.00 "$6,696.82" $0.00 $0.00 "$26,145.55" $0.00 $0.00 "$27,162.57" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$25,869.11" $0.00 $0.00 $0.00 $0.00 $0.00 MS099 DRG MS099 NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC INPATIENT ONLY "$174,672.76" "$129,257.84" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS100 DRG MS100 SEIZURES WITH MCC INPATIENT ONLY "$113,408.24" "$83,922.10" $0.00 "$127,077.03" "$41,317.50" "$41,317.50" "$28,871.11" "$28,871.11" "$13,659.94" "$16,066.40" $0.00 $0.00 "$16,742.05" "$23,969.93" "$16,066.40" "$24,483.50" "$28,146.00" "$28,146.00" "$26,241.38" "$104,293.01" "$127,077.03" $0.00 "$18,246.24" "$28,146.00" "$18,246.24" $0.00 "$28,009.92" "$28,009.92" "$24,991.79" $0.00 $0.00 $0.00 $0.00 $0.00 MS101 DRG MS101 SEIZURES WITHOUT MCC INPATIENT ONLY "$40,436.43" "$29,922.96" $0.00 "$30,456.31" "$20,980.25" "$20,980.25" "$17,184.76" "$17,184.76" $0.00 "$7,244.17" $0.00 $0.00 $0.00 "$17,168.90" "$7,244.17" "$17,528.46" $0.00 $0.00 "$19,836.12" "$3,828.93" "$30,456.31" "$28,419.72" "$8,850.46" $0.00 "$8,850.46" "$6,933.64" "$20,355.50" "$20,355.50" "$18,891.54" "$7,280.31" $0.00 $0.00 $0.00 $0.00 MS102 DRG MS102 HEADACHES WITH MCC INPATIENT ONLY "$29,362.26" "$21,728.07" $0.00 "$19,391.81" "$8,589.34" "$8,589.34" "$19,011.58" "$19,011.58" $0.00 $0.00 $0.00 $0.00 $0.00 "$18,990.99" $0.00 "$19,391.81" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS103 DRG MS103 HEADACHES WITHOUT MCC INPATIENT ONLY "$49,370.41" "$36,534.10" $0.00 "$19,674.42" "$15,663.02" "$15,663.02" "$16,778.24" "$16,778.24" "$6,172.14" $0.00 $0.00 $0.00 "$6,696.82" "$16,763.43" $0.00 "$17,113.80" "$12,442.50" "$12,442.50" $0.00 $0.00 $0.00 $0.00 $0.00 "$12,442.50" $0.00 "$6,384.88" "$19,674.42" "$19,674.42" $0.00 "$6,704.13" $0.00 $0.00 $0.00 $0.00 MS113 DRG MS113 ORBITAL PROCEDURES WITH CC/MCC INPATIENT ONLY "$138,306.42" "$102,346.75" $0.00 "$276,386.52" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$134,305.87" $0.00 $0.00 "$28,372.83" "$191,344.73" "$233,146.18" "$276,386.52" "$36,547.34" $0.00 "$36,547.34" $0.00 "$30,557.04" "$30,557.04" "$27,021.74" $0.00 $0.00 $0.00 $0.00 $0.00 MS114 DRG MS114 ORBITAL PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$87,408.31" "$64,682.15" $0.00 "$22,869.95" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$21,940.21" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$22,869.95" "$22,869.95" "$20,895.44" $0.00 $0.00 $0.00 $0.00 $0.00 MS115 DRG MS115 EXTRAOCULAR PROCEDURES EXCEPT ORBIT INPATIENT ONLY "$67,898.23" "$50,244.69" $0.00 "$105,509.24" "$105,509.24" "$105,509.24" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS116 DRG MS116 INTRAOCULAR PROCEDURES WITH CC/MCC INPATIENT ONLY "$82,320.88" "$60,917.45" $0.00 "$30,595.31" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$26,725.21" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$30,595.31" $0.00 $0.00 $0.00 $0.00 $0.00 MS117 DRG MS117 INTRAOCULAR PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$367,970.92" "$272,298.48" $0.00 "$239,144.21" $0.00 $0.00 $0.00 $0.00 "$61,633.31" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$239,144.21" "$239,144.21" $0.00 $0.00 $0.00 $0.00 $0.00 "$239,144.21" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS121 DRG MS121 ACUTE MAJOR EYE INFECTIONS WITH CC/MCC INPATIENT ONLY "$15,973.21" "$11,820.18" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS123 DRG MS123 NEUROLOGICAL EYE DISORDERS INPATIENT ONLY "$44,663.68" "$33,051.12" $0.00 "$16,672.44" $0.00 $0.00 "$16,345.53" "$16,345.53" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$16,672.44" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS124 DRG MS124 OTHER DISORDERS OF THE EYE WITH MCC INPATIENT ONLY "$29,314.17" "$21,692.49" $0.00 "$26,180.77" "$26,180.77" "$26,180.77" "$20,729.36" "$20,729.36" "$10,203.89" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$21,143.95" "$21,030.00" "$21,030.00" $0.00 "$3,939.75" "$21,706.29" $0.00 "$13,927.76" "$21,030.00" "$13,927.76" $0.00 "$24,491.81" "$24,491.81" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS125 DRG MS125 OTHER DISORDERS OF THE EYE WITHOUT MCC INPATIENT ONLY "$41,942.08" "$31,037.14" $0.00 "$19,591.92" $0.00 $0.00 "$16,830.03" "$16,830.03" $0.00 $0.00 $0.00 $0.00 "$6,552.22" $0.00 $0.00 "$17,166.63" $0.00 $0.00 "$19,197.14" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$19,591.92" "$19,591.92" "$18,282.99" $0.00 $0.00 $0.00 $0.00 $0.00 MS137 DRG MS137 MOUTH PROCEDURES WITH CC/MCC INPATIENT ONLY "$21,396.53" "$15,833.43" $0.00 "$22,914.03" "$13,358.33" "$13,358.33" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$22,914.03" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$8,380.67" $0.00 $0.00 "$21,822.89" "$8,799.70" $0.00 $0.00 $0.00 $0.00 MS138 DRG MS138 MOUTH PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$106,064.54" "$78,487.76" $0.00 "$17,303.89" "$8,601.10" "$8,601.10" "$16,964.60" "$16,964.60" $0.00 $0.00 $0.00 $0.00 "$17,079.99" "$16,949.30" $0.00 "$17,303.89" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS139 DRG MS139 SALIVARY GLAND PROCEDURES INPATIENT ONLY $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS140 DRG MS140 MAJOR HEAD AND NECK PROCEDURES WITH MCC INPATIENT ONLY "$309,670.31" "$229,156.03" $0.00 "$213,352.18" "$194,628.71" "$194,628.71" "$60,708.75" "$60,708.75" "$194,363.69" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$213,352.18" "$213,352.18" "$213,352.18" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS141 DRG MS141 MAJOR HEAD AND NECK PROCEDURES WITH CC INPATIENT ONLY "$205,684.54" "$152,206.56" $0.00 "$93,559.19" $0.00 $0.00 "$26,278.86" "$26,278.86" $0.00 $0.00 $0.00 $0.00 "$93,559.19" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS142 DRG MS142 MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$165,428.82" "$122,417.33" $0.00 "$124,242.12" "$91,709.28" "$91,709.28" $0.00 $0.00 "$24,814.35" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$124,242.12" "$124,242.12" "$124,242.12" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS143 DRG MS143 "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC" INPATIENT ONLY "$304,173.95" "$225,088.72" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS144 DRG MS144 "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC" INPATIENT ONLY "$18,109.68" "$13,401.16" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS145 DRG MS145 "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC" INPATIENT ONLY "$93,894.95" "$69,482.26" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS146 DRG MS146 "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC" INPATIENT ONLY "$179,849.11" "$133,088.34" $0.00 "$28,926.04" $0.00 $0.00 "$25,140.12" "$25,140.12" $0.00 $0.00 $0.00 $0.00 $0.00 "$25,103.67" $0.00 "$25,642.92" $0.00 $0.00 "$26,982.15" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$28,926.04" "$28,926.04" "$25,697.29" $0.00 $0.00 $0.00 $0.00 $0.00 MS147 DRG MS147 "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC" INPATIENT ONLY "$66,379.23" "$49,120.63" $0.00 "$97,982.21" "$97,982.21" "$97,982.21" "$20,033.00" "$20,033.00" $0.00 $0.00 $0.00 $0.00 $0.00 "$20,009.77" $0.00 "$20,433.66" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS149 DRG MS149 DYSEQUILIBRIUM INPATIENT ONLY "$20,824.61" "$15,410.21" $0.00 "$19,110.92" $0.00 $0.00 "$16,139.87" "$16,139.87" $0.00 $0.00 $0.00 $0.00 $0.00 "$16,126.71" $0.00 "$16,462.67" $0.00 $0.00 "$18,794.64" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$19,110.92" "$19,110.92" "$17,899.66" $0.00 $0.00 $0.00 $0.00 $0.00 MS150 DRG MS150 EPISTAXIS WITH MCC INPATIENT ONLY "$39,367.10" "$29,131.65" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS152 DRG MS152 OTITIS MEDIA AND URI WITH MCC INPATIENT ONLY "$24,484.17" "$18,118.29" $0.00 "$20,902.85" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$13,393.64" $0.00 $0.00 $0.00 $0.00 $0.00 "$20,902.85" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$19,907.48" $0.00 $0.00 $0.00 $0.00 $0.00 MS153 DRG MS153 OTITIS MEDIA AND URI WITHOUT MCC INPATIENT ONLY "$23,118.21" "$17,107.48" $0.00 "$18,914.10" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$10,415.87" "$16,796.75" $0.00 "$7,081.17" $0.00 "$7,081.17" $0.00 "$18,914.10" "$18,914.10" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS154 DRG MS154 "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC" INPATIENT ONLY "$93,847.35" "$69,447.04" $0.00 "$22,163.26" $0.00 $0.00 "$21,728.69" "$21,728.69" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$22,163.26" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS155 DRG MS155 "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC" INPATIENT ONLY "$43,876.11" "$32,468.32" $0.00 "$20,504.12" $0.00 $0.00 "$17,330.38" "$17,330.38" $0.00 $0.00 $0.00 $0.00 $0.00 "$17,314.14" $0.00 "$17,676.99" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$6,166.65" "$20,504.12" "$20,504.12" $0.00 "$6,474.98" $0.00 $0.00 $0.00 $0.00 MS156 DRG MS156 "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC" INPATIENT ONLY "$23,686.23" "$17,527.81" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS157 DRG MS157 DENTAL AND ORAL DISEASES WITH MCC INPATIENT ONLY "$74,941.49" "$55,456.70" $0.00 "$25,908.70" $0.00 $0.00 "$21,931.61" "$21,931.61" $0.00 $0.00 $0.00 $0.00 "$21,981.73" "$21,903.46" $0.00 "$22,370.24" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$25,908.70" "$25,908.70" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS158 DRG MS158 DENTAL AND ORAL DISEASES WITH CC INPATIENT ONLY "$78,110.53" "$57,801.79" $0.00 "$20,222.38" $0.00 $0.00 "$17,266.18" "$17,266.18" $0.00 $0.00 $0.00 $0.00 $0.00 "$17,250.11" $0.00 "$17,611.50" $0.00 $0.00 "$19,724.72" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$8,376.14" "$20,222.38" "$20,222.38" "$18,785.45" "$8,794.95" $0.00 $0.00 $0.00 $0.00 MS159 DRG MS159 DENTAL AND ORAL DISEASES WITHOUT CC/MCC INPATIENT ONLY "$77,636.24" "$57,450.82" $0.00 "$49,192.35" "$17,283.48" "$17,283.48" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$18,401.02" "$7,632.24" "$49,192.35" $0.00 "$6,745.36" $0.00 "$6,745.36" $0.00 "$18,640.54" "$18,640.54" "$17,524.78" $0.00 $0.00 $0.00 $0.00 $0.00 MS163 DRG MS163 MAJOR CHEST PROCEDURES WITH MCC INPATIENT ONLY "$279,043.80" "$206,492.41" $0.00 "$296,439.13" "$137,000.36" "$137,000.36" $0.00 $0.00 $0.00 "$51,285.84" $0.00 $0.00 "$112,921.68" $0.00 "$53,850.16" "$48,524.14" $0.00 $0.00 $0.00 "$243,289.68" "$296,439.13" $0.00 "$60,731.26" $0.00 "$60,731.26" $0.00 "$52,946.21" "$52,946.21" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS164 DRG MS164 MAJOR CHEST PROCEDURES WITH CC INPATIENT ONLY "$282,327.09" "$208,922.05" $0.00 "$223,039.12" "$220,306.22" "$220,306.22" $0.00 $0.00 "$62,096.21" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$223,039.12" "$223,039.12" "$31,102.90" "$182,933.69" "$222,897.67" $0.00 "$34,322.38" "$223,039.12" "$34,322.38" $0.00 "$33,819.53" "$33,819.53" "$29,621.81" $0.00 $0.00 $0.00 $0.00 $0.00 MS165 DRG MS165 MAJOR CHEST PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$65,007.56" "$48,105.59" $0.00 "$28,246.73" $0.00 $0.00 "$24,280.88" "$24,280.88" $0.00 $0.00 $0.00 $0.00 $0.00 "$24,246.64" $0.00 "$24,766.50" $0.00 $0.00 "$26,439.54" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$28,246.73" "$28,246.73" "$25,180.51" $0.00 $0.00 $0.00 $0.00 $0.00 MS166 DRG MS166 OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC INPATIENT ONLY "$178,026.71" "$131,739.77" $0.00 "$55,255.73" $0.00 $0.00 "$36,751.19" "$36,751.19" $0.00 $0.00 $0.00 $0.00 $0.00 "$36,684.69" $0.00 "$37,486.21" $0.00 $0.00 "$39,297.27" "$16,179.17" "$55,255.73" $0.00 "$37,397.68" $0.00 "$37,397.68" $0.00 "$43,611.96" "$43,611.96" "$47,571.93" $0.00 $0.00 $0.00 $0.00 $0.00 MS167 DRG MS167 OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC INPATIENT ONLY "$133,062.87" "$98,466.52" $0.00 "$32,510.42" $0.00 $0.00 "$23,605.22" "$23,605.22" $0.00 $0.00 $0.00 $0.00 $0.00 "$23,572.75" $0.00 "$24,077.32" $0.00 $0.00 "$26,885.12" "$16,604.60" "$32,510.42" $0.00 "$19,190.53" $0.00 "$19,190.53" "$17,468.56" "$28,779.21" "$28,779.21" "$25,604.88" "$18,341.98" $0.00 $0.00 $0.00 $0.00 MS168 DRG MS168 OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$296,531.05" "$219,432.98" $0.00 "$22,868.93" $0.00 $0.00 "$20,400.85" "$20,400.85" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$17,511.55" $0.00 $0.00 "$22,868.93" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$21,779.93" $0.00 $0.00 $0.00 $0.00 $0.00 MS175 DRG MS175 PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE INPATIENT ONLY "$46,945.21" "$34,739.46" $0.00 "$38,070.00" "$26,408.34" "$26,408.34" "$21,723.17" "$21,723.17" $0.00 $0.00 $0.00 $0.00 $0.00 "$21,695.56" $0.00 "$22,157.63" $0.00 $0.00 "$23,432.41" "$16,704.06" "$38,070.00" $0.00 "$14,479.10" $0.00 "$14,479.10" $0.00 "$24,940.97" "$24,940.97" "$22,316.58" $0.00 $0.00 $0.00 $0.00 $0.00 MS176 DRG MS176 PULMONARY EMBOLISM WITHOUT MCC INPATIENT ONLY "$35,673.42" "$26,398.33" $0.00 "$18,666.99" $0.00 $0.00 "$17,180.62" "$17,180.62" $0.00 $0.00 $0.00 $0.00 "$3,348.41" "$16,508.75" $0.00 "$17,524.23" $0.00 $0.00 "$18,666.99" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$7,736.43" "$18,474.68" "$18,474.68" "$18,666.99" "$8,233.74" $0.00 $0.00 $0.00 $0.00 MS177 DRG MS177 RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC INPATIENT ONLY "$54,920.67" "$40,641.30" $0.00 "$35,112.81" "$24,674.54" "$24,674.54" "$29,566.11" "$29,566.11" "$17,398.03" "$18,110.89" $0.00 $0.00 "$24,142.73" "$29,518.11" "$18,110.89" "$30,157.43" "$27,736.50" "$27,736.50" "$26,726.58" "$8,082.82" "$21,757.37" "$11,693.56" "$18,957.97" "$27,736.50" "$18,957.97" "$2,527.77" "$35,112.81" "$35,112.81" "$30,597.17" "$2,690.25" $0.00 $0.00 $0.00 $0.00 MS178 DRG MS178 RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC INPATIENT ONLY "$41,304.99" "$30,565.69" $0.00 "$31,014.33" "$4,086.60" "$4,086.60" "$23,653.50" "$23,653.50" $0.00 $0.00 $0.00 $0.00 $0.00 "$19,367.53" $0.00 "$30,157.43" $0.00 $0.00 "$22,298.99" "$10,783.80" "$31,014.33" "$27,319.11" "$12,463.21" $0.00 "$12,463.21" "$3,578.23" "$27,587.02" "$27,587.02" "$24,618.39" "$3,808.24" $0.00 $0.00 $0.00 $0.00 MS179 DRG MS179 RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC INPATIENT ONLY "$14,995.29" "$11,096.51" $0.00 "$27,548.37" $0.00 $0.00 $0.00 $0.00 $0.00 "$6,204.24" $0.00 $0.00 $0.00 $0.00 "$6,880.87" $858.97 $0.00 $0.00 "$19,721.29" "$12,770.64" "$27,548.37" "$11,997.43" "$8,682.05" $0.00 "$8,682.05" $0.00 "$23,205.61" "$23,205.61" "$21,137.62" $0.00 $0.00 $0.00 $0.00 $0.00 MS180 DRG MS180 RESPIRATORY NEOPLASMS WITH MCC INPATIENT ONLY "$96,534.84" "$71,435.78" $0.00 "$27,231.65" $0.00 $0.00 "$23,061.38" "$23,061.38" $0.00 $0.00 $0.00 $0.00 "$23,438.87" "$23,030.30" $0.00 "$23,522.61" $0.00 $0.00 "$25,590.12" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$27,231.65" "$27,231.65" "$24,371.54" $0.00 $0.00 $0.00 $0.00 $0.00 MS181 DRG MS181 RESPIRATORY NEOPLASMS WITH CC INPATIENT ONLY "$48,052.18" "$35,558.61" $0.00 "$22,553.09" "$4,515.45" "$4,515.45" "$18,783.83" "$18,783.83" $0.00 $0.00 $0.00 $0.00 $0.00 "$18,763.84" $0.00 "$19,159.51" $0.00 $0.00 "$21,675.08" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$22,553.09" "$22,553.09" "$20,642.93" $0.00 $0.00 $0.00 $0.00 $0.00 MS182 DRG MS182 RESPIRATORY NEOPLASMS WITHOUT CC/MCC INPATIENT ONLY "$48,193.46" "$35,663.16" $0.00 "$19,562.08" "$16,511.68" "$16,511.68" $0.00 $0.00 "$7,219.13" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$11,880.00" "$11,880.00" "$19,562.08" $0.00 $0.00 $0.00 $0.00 "$11,880.00" $0.00 $0.00 $0.00 $0.00 "$18,630.55" $0.00 $0.00 $0.00 $0.00 $0.00 MS183 DRG MS183 MAJOR CHEST TRAUMA WITH MCC INPATIENT ONLY "$71,723.96" "$53,075.73" $0.00 "$24,116.10" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$18,601.98" $0.00 $0.00 "$24,116.10" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$22,967.71" $0.00 $0.00 $0.00 $0.00 $0.00 MS184 DRG MS184 MAJOR CHEST TRAUMA WITH CC INPATIENT ONLY "$80,313.41" "$59,431.92" $0.00 "$68,413.61" "$22,437.76" "$22,437.76" "$18,237.24" "$18,237.24" $0.00 $0.00 $0.00 $0.00 "$68,413.61" "$18,218.65" $0.00 "$18,601.98" $0.00 $0.00 "$20,760.71" "$52,951.87" "$64,519.81" $0.00 "$10,206.75" $0.00 "$10,206.75" $0.00 "$21,460.41" "$21,460.41" "$19,772.10" $0.00 $0.00 $0.00 $0.00 $0.00 MS185 DRG MS185 MAJOR CHEST TRAUMA WITHOUT CC/MCC INPATIENT ONLY "$50,595.65" "$37,440.78" $0.00 "$19,139.50" "$12,596.89" "$12,596.89" "$16,401.44" "$16,401.44" "$5,915.97" $0.00 $0.00 $0.00 "$16,934.46" "$16,387.60" $0.00 "$16,729.47" "$11,623.50" "$11,623.50" $0.00 $0.00 $0.00 $0.00 $0.00 "$11,623.50" $0.00 $0.00 "$19,139.50" "$19,139.50" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS186 DRG MS186 PLEURAL EFFUSION WITH MCC INPATIENT ONLY "$30,155.37" "$22,314.97" $0.00 "$39,070.27" $0.00 $0.00 "$18,487.14" "$18,487.14" $0.00 $0.00 $0.00 $0.00 $0.00 "$39,070.27" $0.00 "$18,856.88" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$31,067.06" "$31,067.06" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS187 DRG MS187 PLEURAL EFFUSION WITH CC INPATIENT ONLY "$66,163.36" "$48,960.89" $0.00 "$20,826.98" $0.00 $0.00 "$18,182.03" "$18,182.03" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$18,545.67" $0.00 $0.00 "$20,826.98" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$19,835.22" $0.00 $0.00 $0.00 $0.00 $0.00 MS188 DRG MS188 PLEURAL EFFUSION WITHOUT CC/MCC INPATIENT ONLY "$23,754.99" "$17,578.69" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS189 DRG MS189 PULMONARY EDEMA AND RESPIRATORY FAILURE INPATIENT ONLY "$40,618.71" "$30,057.85" $0.00 "$36,477.30" "$25,196.85" "$25,196.85" "$19,549.83" "$19,549.83" "$9,782.23" "$12,640.58" $0.00 $0.00 "$3,348.41" "$19,493.51" "$13,272.61" "$19,905.70" "$9,782.23" "$9,782.23" "$22,110.38" "$15,587.39" "$36,477.30" "$26,164.57" "$12,186.54" "$9,782.23" "$12,186.54" $0.00 "$23,073.29" "$23,073.29" "$21,057.50" $0.00 $0.00 $0.00 $0.00 $0.00 MS190 DRG MS190 CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC INPATIENT ONLY "$22,075.42" "$16,335.81" $0.00 "$22,487.76" "$8,385.55" "$8,385.55" "$17,727.21" "$17,727.21" $0.00 "$10,092.46" $0.00 $0.00 $0.00 "$18,798.25" "$10,597.09" "$19,194.71" $0.00 $0.00 "$21,620.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$22,487.76" "$22,487.76" "$20,590.86" $0.00 $0.00 $0.00 $0.00 $0.00 MS191 DRG MS191 CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC INPATIENT ONLY "$27,212.46" "$20,137.22" $0.00 "$20,436.33" $0.00 $0.00 "$17,156.46" "$17,156.46" $0.00 "$14,254.34" $0.00 $0.00 $0.00 "$17,140.67" "$8,483.54" "$17,499.59" $0.00 $0.00 "$19,903.76" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$20,436.33" "$20,436.33" "$18,955.96" $0.00 $0.00 $0.00 $0.00 $0.00 MS192 DRG MS192 CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC INPATIENT ONLY "$39,809.35" "$29,458.92" $0.00 "$18,936.98" "$8,173.20" "$8,173.20" "$15,854.15" "$15,854.15" $0.00 $0.00 $0.00 $0.00 "$3,348.41" $0.00 $0.00 "$16,171.23" $0.00 $0.00 "$18,649.09" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$18,936.98" "$18,936.98" "$17,761.04" $0.00 $0.00 $0.00 $0.00 $0.00 MS193 DRG MS193 SIMPLE PNEUMONIA AND PLEURISY WITH MCC INPATIENT ONLY "$53,920.15" "$39,900.91" $0.00 "$43,491.25" "$24,519.60" "$24,519.60" "$20,108.24" "$20,108.24" $0.00 $0.00 $0.00 $0.00 $0.00 "$20,084.80" $0.00 "$20,510.40" $0.00 $0.00 "$22,915.39" "$3,781.24" "$33,085.28" "$43,491.25" "$13,367.42" $0.00 "$13,367.42" "$12,168.50" "$24,035.30" "$24,035.30" "$21,824.18" "$12,776.92" $0.00 $0.00 $0.00 $0.00 MS194 DRG MS194 SIMPLE PNEUMONIA AND PLEURISY WITH CC INPATIENT ONLY "$23,780.48" "$17,597.56" $0.00 "$20,557.21" $0.00 $0.00 "$17,015.67" "$17,015.67" $0.00 $0.00 $0.00 $0.00 $0.00 "$17,000.25" $0.00 "$17,355.98" $0.00 $0.00 "$19,875.06" "$6,896.00" "$20,557.21" $0.00 "$8,907.60" $0.00 "$8,907.60" "$2,899.29" "$20,402.05" "$20,402.05" "$18,928.63" "$3,085.65" $0.00 $0.00 $0.00 $0.00 MS195 DRG MS195 SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC INPATIENT ONLY "$27,752.98" "$20,537.21" $0.00 "$18,715.67" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$10,045.23" $0.00 $0.00 $0.00 $0.00 $0.00 "$18,463.89" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,926.47" "$18,715.67" "$18,715.67" "$17,584.66" "$3,114.59" $0.00 $0.00 $0.00 $0.00 MS196 DRG MS196 INTERSTITIAL LUNG DISEASE WITH MCC INPATIENT ONLY "$62,019.94" "$45,894.76" $0.00 "$50,112.69" "$4,298.95" "$4,298.95" "$23,052.43" "$23,052.43" $0.00 $0.00 $0.00 $0.00 $0.00 "$23,021.37" $0.00 "$23,513.48" $0.00 $0.00 "$25,251.85" "$24,703.77" "$50,112.69" $0.00 "$16,794.73" $0.00 "$16,794.73" $0.00 "$26,827.41" "$26,827.41" "$24,049.38" $0.00 $0.00 $0.00 $0.00 $0.00 MS197 DRG MS197 INTERSTITIAL LUNG DISEASE WITH CC INPATIENT ONLY "$33,882.40" "$25,072.98" $0.00 "$21,487.37" $0.00 $0.00 "$18,003.28" "$18,003.28" $0.00 $0.00 $0.00 $0.00 $0.00 "$17,985.30" $0.00 "$18,363.35" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$21,487.37" "$21,487.37" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS198 DRG MS198 INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC INPATIENT ONLY "$58,135.75" "$43,020.46" $0.00 "$6,417.29" $0.00 $0.00 $0.00 $0.00 $0.00 "$6,111.70" $0.00 $0.00 $0.00 $0.00 "$6,417.29" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS199 DRG MS199 PNEUMOTHORAX WITH MCC INPATIENT ONLY "$87,933.44" "$65,070.75" $0.00 "$71,834.87" "$22,271.35" "$22,271.35" "$28,615.62" "$28,615.62" "$16,374.25" "$20,990.30" $0.00 $0.00 $0.00 "$33,369.82" "$20,995.35" "$29,187.93" "$26,850.00" "$26,850.00" $0.00 "$19,741.79" "$71,834.87" $0.00 "$17,984.61" "$26,850.00" "$17,984.61" "$13,711.52" "$27,796.78" "$27,796.78" $0.00 "$14,397.09" $0.00 $0.00 $0.00 $0.00 MS200 DRG MS200 PNEUMOTHORAX WITH CC INPATIENT ONLY "$88,938.55" "$65,814.53" $0.00 "$41,863.22" "$26,577.44" "$26,577.44" "$18,482.92" "$18,482.92" "$9,000.71" "$7,212.00" $0.00 $0.00 "$7,290.56" $0.00 "$7,212.00" "$18,852.58" "$16,147.50" "$16,147.50" "$21,197.39" "$7,597.89" "$33,230.54" "$41,863.22" "$10,847.31" "$16,147.50" "$10,847.31" "$6,902.85" "$21,982.26" "$21,982.26" "$20,187.99" "$7,247.99" $0.00 $0.00 $0.00 $0.00 MS201 DRG MS201 PNEUMOTHORAX WITHOUT CC/MCC INPATIENT ONLY "$18,226.67" "$13,487.74" $0.00 "$28,659.30" "$28,659.30" "$28,659.30" $0.00 $0.00 $0.00 "$5,832.61" $0.00 $0.00 $0.00 $0.00 "$5,832.61" "$16,269.80" $0.00 $0.00 "$18,709.23" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$17,818.31" $0.00 $0.00 $0.00 $0.00 $0.00 MS202 DRG MS202 BRONCHITIS AND ASTHMA WITH CC/MCC INPATIENT ONLY "$27,125.85" "$20,073.13" $0.00 "$20,887.13" "$8,642.61" "$8,642.61" "$17,727.21" "$17,727.21" $0.00 "$7,793.93" $0.00 $0.00 $0.00 $0.00 "$8,183.63" "$18,081.75" $0.00 $0.00 "$20,280.98" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$20,887.13" "$20,887.13" "$19,315.22" $0.00 $0.00 $0.00 $0.00 $0.00 MS203 DRG MS203 BRONCHITIS AND ASTHMA WITHOUT CC/MCC INPATIENT ONLY "$17,147.67" "$12,689.28" $0.00 "$18,811.21" $0.00 $0.00 "$15,932.82" "$15,932.82" $0.00 "$3,735.21" $0.00 $0.00 "$3,348.41" "$15,920.20" "$5,866.67" "$16,251.48" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$18,811.21" "$18,811.21" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS204 DRG MS204 RESPIRATORY SIGNS AND SYMPTOMS INPATIENT ONLY "$12,787.21" "$9,462.54" $0.00 "$116,821.39" "$114,402.61" "$114,402.61" "$16,530.50" "$16,530.50" "$19,192.69" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$16,861.11" "$116,821.39" "$116,821.39" "$19,354.99" $0.00 $0.00 $0.00 $0.00 "$116,821.39" $0.00 $0.00 "$19,780.56" "$19,780.56" "$18,433.32" $0.00 $0.00 $0.00 $0.00 $0.00 MS205 DRG MS205 OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC INPATIENT ONLY "$71,391.42" "$52,829.65" $0.00 "$46,642.66" "$16,664.62" "$16,664.62" "$27,050.39" "$27,050.39" "$12,495.13" $0.00 $0.00 $0.00 $0.00 "$22,651.02" $0.00 "$27,591.40" "$25,272.00" "$25,272.00" "$24,970.31" "$12,908.72" "$46,642.66" $0.00 "$16,381.71" "$25,272.00" "$16,381.71" $0.00 "$26,490.96" "$26,490.96" "$23,781.25" $0.00 $0.00 $0.00 $0.00 $0.00 MS206 DRG MS206 OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC INPATIENT ONLY "$30,695.99" "$22,715.03" $0.00 "$34,911.74" $0.00 $0.00 "$17,168.19" "$17,168.19" $0.00 "$6,502.44" $0.00 $0.00 "$10,045.23" "$17,152.37" "$6,502.44" $0.00 $0.00 $0.00 "$19,765.04" "$4,150.00" "$34,911.74" $0.00 "$8,746.21" $0.00 "$8,746.21" $0.00 "$20,270.57" "$20,270.57" "$18,823.85" $0.00 $0.00 $0.00 $0.00 $0.00 MS207 DRG MS207 RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS INPATIENT ONLY "$381,382.83" "$282,223.29" $0.00 "$350,029.12" "$136,076.60" "$136,076.60" "$50,641.13" "$50,641.13" $0.00 "$62,949.70" $0.00 $0.00 "$7,290.56" "$50,538.71" "$66,097.21" "$51,653.95" $0.00 $0.00 "$50,474.52" "$287,271.37" "$350,029.12" $0.00 "$78,281.84" $0.00 "$78,281.84" $0.00 "$59,984.89" "$59,984.89" "$50,474.52" $0.00 $0.00 $0.00 $0.00 $0.00 MS208 DRG MS208 RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS INPATIENT ONLY "$129,996.22" "$96,197.20" $0.00 "$33,431.63" "$26,856.98" "$26,856.98" "$28,616.41" "$28,616.41" $0.00 $0.00 $0.00 $0.00 $0.00 "$28,570.95" $0.00 "$29,188.74" $0.00 $0.00 "$30,778.29" "$5,386.48" "$22,287.15" $0.00 "$24,901.37" $0.00 "$24,901.37" $0.00 "$33,431.63" "$33,431.63" "$29,312.66" $0.00 $0.00 $0.00 $0.00 $0.00 MS215 DRG MS215 OTHER HEART ASSIST SYSTEM IMPLANT INPATIENT ONLY "$302,673.62" "$223,978.48" $0.00 "$426,802.21" "$177,689.39" "$177,689.39" "$83,922.24" "$83,922.24" $0.00 $0.00 $0.00 $0.00 "$3,645.28" $0.00 $0.00 "$85,600.68" $0.00 $0.00 "$101,862.99" "$350,279.60" "$426,802.21" $0.00 "$129,174.20" $0.00 "$129,174.20" $0.00 "$118,379.20" "$118,379.20" "$97,012.37" $0.00 $0.00 $0.00 $0.00 $0.00 MS216 DRG MS216 CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC INPATIENT ONLY "$844,071.58" "$624,612.97" $0.00 "$363,816.68" "$363,816.68" "$363,816.68" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$95,156.23" "$95,156.23" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS219 DRG MS219 CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC INPATIENT ONLY "$652,285.78" "$482,691.48" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS220 DRG MS220 CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC INPATIENT ONLY "$834,118.48" "$617,247.68" $0.00 "$314,960.76" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$258,490.53" "$314,960.76" $0.00 "$67,066.33" $0.00 "$67,066.33" $0.00 "$56,475.77" "$56,475.77" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS222 DRG MS222 "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI, HF OR SHOCK WITH MCC" INPATIENT ONLY "$557,934.66" "$412,871.65" $0.00 "$652,154.79" "$652,154.79" "$652,154.79" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$81,291.22" "$81,291.22" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS224 DRG MS224 "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI, HF OR SHOCK WITH MCC" INPATIENT ONLY "$224,109.48" "$165,841.02" $0.00 "$66,349.55" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$66,349.55" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$63,190.05" $0.00 $0.00 $0.00 $0.00 $0.00 MS225 DRG MS225 "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI, HF OR SHOCK WITHOUT MCC" INPATIENT ONLY "$304,647.12" "$225,438.87" $0.00 "$59,276.04" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$49,909.59" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$59,276.04" "$59,276.04" "$49,909.59" $0.00 $0.00 $0.00 $0.00 $0.00 MS226 DRG MS226 CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITH MCC INPATIENT ONLY "$262,894.89" "$194,542.22" $0.00 "$59,504.66" $0.00 $0.00 "$56,361.78" "$56,361.78" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$57,489.02" $0.00 $0.00 "$59,504.66" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$56,671.10" $0.00 $0.00 $0.00 $0.00 $0.00 MS227 DRG MS227 CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC INPATIENT ONLY "$237,743.92" "$175,930.50" $0.00 "$47,965.26" $0.00 $0.00 "$47,024.76" "$47,024.76" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$47,965.26" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS228 DRG MS228 OTHER CARDIOTHORACIC PROCEDURES WITH MCC INPATIENT ONLY "$357,913.50" "$264,855.99" $0.00 "$66,076.66" $0.00 $0.00 "$47,840.51" "$47,840.51" $0.00 $0.00 $0.00 $0.00 $0.00 "$47,745.32" $0.00 "$48,797.32" $0.00 $0.00 "$66,076.66" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$64,482.16" "$64,482.16" "$66,076.66" $0.00 $0.00 $0.00 $0.00 $0.00 MS233 DRG MS233 CORONARY BYPASS WITH CARDIAC CATHETERIZATION WITH MCC INPATIENT ONLY "$709,784.74" "$525,240.71" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS234 DRG MS234 CORONARY BYPASS WITH CARDIAC CATHETERIZATION WITHOUT MCC INPATIENT ONLY "$480,271.74" "$355,401.09" $0.00 "$55,662.39" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$55,662.39" "$55,662.39" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS235 DRG MS235 CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC INPATIENT ONLY "$433,659.48" "$320,908.02" $0.00 "$82,191.24" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$46,536.69" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$82,191.24" "$82,191.24" "$44,320.66" $0.00 $0.00 $0.00 $0.00 $0.00 MS236 DRG MS236 CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC INPATIENT ONLY "$407,163.36" "$301,300.89" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS239 DRG MS239 AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC INPATIENT ONLY "$309,142.02" "$228,765.09" $0.00 "$520,828.58" $0.00 $0.00 "$40,051.71" "$40,051.71" $0.00 $0.00 $0.00 $0.00 $0.00 "$40,042.67" $0.00 "$30,906.38" $0.00 $0.00 "$45,984.42" "$427,447.72" "$520,828.58" $0.00 "$126,573.84" $0.00 "$126,573.84" $0.00 "$51,280.25" "$51,280.25" "$43,794.69" $0.00 $0.00 $0.00 $0.00 $0.00 MS240 DRG MS240 AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC INPATIENT ONLY "$156,536.31" "$115,836.87" $0.00 "$197,317.38" $0.00 $0.00 "$30,300.37" "$30,300.37" $0.00 $0.00 $0.00 $0.00 "$197,317.38" "$30,250.57" $0.00 "$30,906.38" $0.00 $0.00 "$32,140.33" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$35,684.78" "$35,684.78" "$32,140.33" $0.00 $0.00 $0.00 $0.00 $0.00 MS241 DRG MS241 AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC INPATIENT ONLY "$120,662.24" "$89,290.06" $0.00 "$25,528.14" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$25,528.14" "$25,528.14" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS242 DRG MS242 PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC INPATIENT ONLY "$265,067.17" "$196,149.71" $0.00 "$43,451.88" $0.00 $0.00 "$36,779.50" "$36,779.50" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$43,451.88" "$43,451.88" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS243 DRG MS243 PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC INPATIENT ONLY "$158,068.54" "$116,970.72" $0.00 "$29,003.59" $0.00 $0.00 "$28,434.89" "$28,434.89" $0.00 $0.00 $0.00 $0.00 $0.00 "$28,389.92" $0.00 "$29,003.59" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS244 DRG MS244 PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC INPATIENT ONLY "$95,847.00" "$70,926.78" $0.00 "$30,094.00" $0.00 $0.00 "$25,293.32" "$25,293.32" $0.00 $0.00 $0.00 $0.00 $0.00 "$25,256.47" $0.00 "$25,799.19" $0.00 $0.00 "$27,985.36" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$30,094.00" "$30,094.00" "$26,652.72" $0.00 $0.00 $0.00 $0.00 $0.00 MS245 DRG MS245 AICD GENERATOR PROCEDURES INPATIENT ONLY "$152,256.14" "$112,669.54" $0.00 "$49,413.28" $0.00 $0.00 "$48,444.39" "$48,444.39" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$49,413.28" $0.00 $0.00 "$49,391.39" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$47,039.42" $0.00 $0.00 $0.00 $0.00 $0.00 MS246 DRG MS246 PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS INPATIENT ONLY "$209,787.55" "$155,242.79" $0.00 "$121,561.11" "$24,732.19" "$24,732.19" "$32,615.82" "$32,615.82" $0.00 $0.00 $0.00 $0.00 "$121,561.11" "$32,560.02" $0.00 "$33,268.14" $0.00 $0.00 "$35,484.73" "$17,653.94" "$81,055.22" $0.00 "$31,805.11" $0.00 "$31,805.11" $0.00 "$39,055.90" "$39,055.90" "$33,794.98" $0.00 $0.00 $0.00 $0.00 $0.00 MS247 DRG MS247 PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC INPATIENT ONLY "$113,312.93" "$83,851.57" $0.00 "$74,539.79" "$15,580.11" "$15,580.11" "$24,671.50" "$24,671.50" $0.00 $0.00 $0.00 $0.00 "$3,348.41" "$24,636.27" $0.00 "$25,164.93" $0.00 $0.00 "$27,707.22" "$30,001.65" "$74,539.79" "$58,858.96" "$20,396.45" $0.00 "$20,396.45" $0.00 "$29,761.63" "$29,761.63" "$26,387.83" $0.00 $0.00 $0.00 $0.00 $0.00 MS248 DRG MS248 PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS INPATIENT ONLY "$176,079.18" "$130,298.59" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS249 DRG MS249 PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITHOUT MCC INPATIENT ONLY "$68,186.12" "$50,457.73" $0.00 "$26,900.15" $0.00 $0.00 "$23,984.81" "$23,984.81" $0.00 $0.00 $0.00 $0.00 $0.00 "$23,951.35" $0.00 "$24,464.51" $0.00 $0.00 "$26,900.15" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$25,619.19" $0.00 $0.00 $0.00 $0.00 $0.00 MS250 DRG MS250 PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITH MCC INPATIENT ONLY "$159,798.37" "$118,250.79" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS251 DRG MS251 PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITHOUT MCC INPATIENT ONLY "$72,880.41" "$53,931.50" $0.00 "$14,906.70" $0.00 $0.00 $0.00 $0.00 $0.00 "$14,894.34" $0.00 $0.00 $0.00 $0.00 "$14,906.70" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS252 DRG MS252 OTHER VASCULAR PROCEDURES WITH MCC INPATIENT ONLY "$145,151.23" "$107,411.91" $0.00 "$169,852.02" "$12,259.80" "$12,259.80" "$34,005.79" "$34,005.79" $0.00 $0.00 $0.00 $0.00 "$169,852.02" "$33,946.40" $0.00 "$34,685.91" $0.00 $0.00 "$36,220.00" $0.00 $0.00 "$100,414.90" $0.00 $0.00 $0.00 $0.00 "$39,934.57" "$39,934.57" "$34,495.24" $0.00 $0.00 $0.00 $0.00 $0.00 MS253 DRG MS253 OTHER VASCULAR PROCEDURES WITH CC INPATIENT ONLY "$129,099.23" "$95,533.43" $0.00 "$34,432.01" $0.00 $0.00 "$29,367.29" "$29,367.29" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$29,954.64" $0.00 $0.00 "$31,615.43" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$34,432.01" "$34,432.01" "$30,109.93" $0.00 $0.00 $0.00 $0.00 $0.00 MS254 DRG MS254 OTHER VASCULAR PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$209,675.21" "$155,159.66" $0.00 "$27,238.50" "$7,561.44" "$7,561.44" "$23,585.90" "$23,585.90" "$15,445.08" $0.00 $0.00 $0.00 $0.00 "$23,553.48" $0.00 "$24,057.62" "$27,238.50" "$27,238.50" "$26,240.69" $0.00 $0.00 $0.00 $0.00 "$27,238.50" $0.00 "$17,128.08" $0.00 $0.00 "$24,991.13" "$17,984.48" $0.00 $0.00 $0.00 $0.00 MS255 DRG MS255 UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC INPATIENT ONLY "$101,664.29" "$75,231.57" $0.00 "$85,925.68" "$85,925.68" "$85,925.68" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$31,909.30" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$30,389.81" $0.00 $0.00 $0.00 $0.00 $0.00 MS256 DRG MS256 UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC INPATIENT ONLY "$55,860.77" "$41,336.97" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS258 DRG MS258 CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC INPATIENT ONLY "$237,539.00" "$175,778.86" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS259 DRG MS259 CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC INPATIENT ONLY "$113,151.42" "$83,732.05" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS260 DRG MS260 CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC INPATIENT ONLY "$163,381.24" "$120,902.12" $0.00 "$43,357.97" $0.00 $0.00 "$18,747.12" "$18,747.12" $0.00 $0.00 $0.00 $0.00 $0.00 "$35,609.47" $0.00 "$19,122.06" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$43,357.97" "$43,357.97" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS261 DRG MS261 CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC INPATIENT ONLY "$51,477.15" "$38,093.09" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS262 DRG MS262 CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC INPATIENT ONLY "$57,243.02" "$42,359.83" $0.00 "$11,542.53" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$11,542.53" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS264 DRG MS264 OTHER CIRCULATORY SYSTEM O.R. PROCEDURES INPATIENT ONLY $0.00 $0.00 $0.00 "$39,670.80" $0.00 $0.00 "$33,508.18" "$33,508.18" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$34,178.34" $0.00 $0.00 "$35,999.28" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$39,670.80" "$39,670.80" "$34,285.03" $0.00 $0.00 $0.00 $0.00 $0.00 MS265 DRG MS265 AICD LEAD PROCEDURES INPATIENT ONLY "$281,375.98" "$208,218.23" $0.00 "$35,132.77" $0.00 $0.00 "$34,280.46" "$34,280.46" $0.00 $0.00 $0.00 $0.00 $0.00 "$34,220.36" $0.00 $0.00 $0.00 $0.00 "$35,132.77" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$33,459.78" $0.00 $0.00 $0.00 $0.00 $0.00 MS269 DRG MS269 AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC INPATIENT ONLY "$295,971.85" "$219,019.17" $0.00 "$42,958.09" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$42,958.09" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$40,912.47" $0.00 $0.00 $0.00 $0.00 $0.00 MS270 DRG MS270 OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC INPATIENT ONLY "$509,550.86" "$377,067.64" $0.00 "$340,524.80" "$340,524.80" "$340,524.80" "$46,851.53" "$46,851.53" $0.00 $0.00 $0.00 $0.00 $0.00 "$54,034.64" $0.00 $0.00 $0.00 $0.00 "$48,724.42" "$160,865.70" "$196,008.66" $0.00 "$51,226.20" $0.00 "$51,226.20" $0.00 "$54,877.59" "$54,877.59" "$46,404.21" $0.00 $0.00 $0.00 $0.00 $0.00 MS271 DRG MS271 OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC INPATIENT ONLY "$275,679.20" "$204,002.61" $0.00 "$188,211.42" "$185,320.36" "$185,320.36" "$35,698.21" "$35,698.21" "$185,320.36" "$5,081.42" $0.00 $0.00 $0.00 $0.00 "$5,081.42" $0.00 "$188,211.42" "$188,211.42" "$38,048.73" $0.00 $0.00 "$161,466.25" $0.00 "$188,211.42" $0.00 $0.00 "$42,119.94" "$42,119.94" "$36,236.89" $0.00 $0.00 $0.00 $0.00 $0.00 MS272 DRG MS272 OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$163,285.34" "$120,831.15" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS273 DRG MS273 PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC INPATIENT ONLY "$346,813.41" "$256,641.92" $0.00 "$91,804.70" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$39,157.85" "$44,119.66" "$91,804.70" $0.00 "$37,193.18" $0.00 "$37,193.18" $0.00 "$43,445.35" "$43,445.35" "$37,293.19" $0.00 $0.00 $0.00 $0.00 $0.00 MS274 DRG MS274 PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC INPATIENT ONLY "$132,117.47" "$97,766.93" $0.00 "$35,395.88" $0.00 $0.00 "$33,735.93" "$33,735.93" $0.00 $0.00 $0.00 $0.00 $0.00 "$33,677.24" $0.00 "$34,410.65" $0.00 $0.00 "$35,395.88" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$33,710.36" $0.00 $0.00 $0.00 $0.00 $0.00 MS280 DRG MS280 "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC" INPATIENT ONLY "$61,063.46" "$45,186.96" $0.00 "$306,336.59" "$306,336.59" "$306,336.59" "$22,143.49" "$22,143.49" $0.00 $0.00 $0.00 $0.00 $0.00 "$22,114.79" $0.00 "$22,586.36" $0.00 $0.00 "$24,947.74" "$17,813.05" "$20,968.38" $0.00 "$16,348.64" $0.00 "$16,348.64" $0.00 "$32,089.26" "$32,089.26" "$23,759.75" $0.00 $0.00 $0.00 $0.00 $0.00 MS281 DRG MS281 "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC" INPATIENT ONLY "$26,455.86" "$19,577.34" $0.00 "$42,566.21" "$12,468.89" "$12,468.89" "$17,475.99" "$17,475.99" "$9,146.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$17,825.51" "$13,959.00" "$13,959.00" "$20,422.44" "$13,390.76" "$42,566.21" $0.00 "$9,710.54" "$13,959.00" "$9,710.54" $0.00 "$21,056.17" "$21,056.17" "$19,449.94" $0.00 $0.00 $0.00 $0.00 $0.00 MS282 DRG MS282 "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC" INPATIENT ONLY "$93,190.71" "$68,961.13" $0.00 "$19,171.35" $0.00 $0.00 "$16,064.63" "$16,064.63" $0.00 $0.00 $0.00 $0.00 $0.00 "$16,051.66" $0.00 "$16,385.92" $0.00 $0.00 "$18,845.21" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$19,171.35" "$19,171.35" "$17,947.82" $0.00 $0.00 $0.00 $0.00 $0.00 MS283 DRG MS283 "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC" INPATIENT ONLY "$189,098.49" "$139,932.88" $0.00 "$96,797.90" $0.00 $0.00 "$23,922.70" "$23,922.70" $0.00 $0.00 $0.00 $0.00 $0.00 "$23,889.39" $0.00 "$24,401.15" $0.00 $0.00 "$28,357.09" "$11,537.64" "$96,797.90" $0.00 "$18,040.74" $0.00 "$18,040.74" $0.00 "$27,842.50" "$27,842.50" "$27,006.75" $0.00 $0.00 $0.00 $0.00 $0.00 MS286 DRG MS286 "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC" INPATIENT ONLY "$170,797.89" "$126,390.44" $0.00 "$146,910.87" "$145,102.74" "$145,102.74" "$25,797.14" "$25,797.14" "$34,337.57" $0.00 $0.00 $0.00 $0.00 "$25,758.99" $0.00 "$26,313.08" "$146,910.87" "$146,910.87" "$28,819.07" $0.00 $0.00 $0.00 $0.00 "$146,910.87" $0.00 $0.00 "$31,090.31" "$31,090.31" "$27,446.73" $0.00 $0.00 $0.00 $0.00 $0.00 MS287 DRG MS287 "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC" INPATIENT ONLY "$67,028.40" "$49,601.02" $0.00 "$29,646.46" $0.00 $0.00 "$18,749.32" "$18,749.32" $0.00 $0.00 $0.00 $0.00 $0.00 "$18,729.41" $0.00 "$19,124.31" $0.00 $0.00 "$21,676.42" "$5,663.06" "$29,646.46" $0.00 "$11,550.01" $0.00 "$11,550.01" $0.00 "$22,554.71" "$22,554.71" "$20,644.21" $0.00 $0.00 $0.00 $0.00 $0.00 MS288 DRG MS288 ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC INPATIENT ONLY "$106,406.72" "$78,740.97" $0.00 "$35,135.48" $0.00 $0.00 "$34,446.55" "$34,446.55" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$35,135.48" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$34,846.87" "$34,846.87" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS291 DRG MS291 HEART FAILURE AND SHOCK WITH MCC INPATIENT ONLY "$40,413.15" "$29,905.73" $0.00 "$59,590.83" "$19,939.50" "$19,939.50" "$19,806.64" "$19,806.64" "$13,475.17" "$13,083.40" $0.00 $0.00 "$13,855.47" "$19,783.99" "$13,083.40" "$20,202.77" "$19,024.50" "$19,024.50" "$21,904.23" "$19,843.82" "$59,590.83" $0.00 "$13,490.72" "$19,024.50" "$13,490.72" "$12,522.56" "$24,135.73" "$24,135.73" "$21,904.23" "$13,148.68" $0.00 $0.00 $0.00 $0.00 MS292 DRG MS292 HEART FAILURE AND SHOCK WITH CC INPATIENT ONLY "$31,089.32" "$23,006.10" $0.00 "$83,990.57" "$16,088.88" "$16,088.88" "$17,012.91" "$17,012.91" "$8,768.64" $0.00 $0.00 $0.00 "$23,092.45" "$16,997.50" $0.00 "$17,353.17" "$83,990.57" "$83,990.57" "$19,990.54" "$3,423.49" "$22,244.34" "$25,542.17" "$9,077.01" "$83,990.57" "$9,077.01" $0.00 "$20,540.04" "$20,540.04" "$19,038.61" $0.00 $0.00 $0.00 $0.00 $0.00 MS293 DRG MS293 HEART FAILURE AND SHOCK WITHOUT CC/MCC INPATIENT ONLY "$25,091.99" "$18,568.07" $0.00 "$19,670.90" "$15,852.90" "$15,852.90" "$15,124.67" "$15,124.67" $0.00 $0.00 $0.00 $0.00 "$3,348.41" "$15,114.12" $0.00 "$15,427.16" $0.00 $0.00 "$18,280.74" $0.00 $0.00 "$19,670.90" $0.00 $0.00 $0.00 $0.00 "$18,496.80" "$18,496.80" "$17,410.23" $0.00 $0.00 $0.00 $0.00 $0.00 MS294 DRG MS294 DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC INPATIENT ONLY "$51,250.50" "$37,925.37" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS296 DRG MS296 "CARDIAC ARREST, UNEXPLAINED WITH MCC" INPATIENT ONLY "$60,132.19" "$44,497.82" $0.00 "$55,644.87" $0.00 $0.00 "$22,062.74" "$22,062.74" $0.00 $0.00 $0.00 $0.00 $0.00 "$22,034.25" $0.00 "$22,503.99" $0.00 $0.00 "$24,534.30" $0.00 $0.00 "$55,644.87" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$23,366.00" $0.00 $0.00 $0.00 $0.00 $0.00 MS299 DRG MS299 PERIPHERAL VASCULAR DISORDERS WITH MCC INPATIENT ONLY "$61,640.61" "$45,614.05" $0.00 "$24,984.23" $0.00 $0.00 "$16,477.47" "$16,477.47" $0.00 $0.00 $0.00 $0.00 $0.00 "$21,603.33" $0.00 "$22,063.32" $0.00 $0.00 "$23,709.46" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$24,984.23" "$24,984.23" "$22,580.44" $0.00 $0.00 $0.00 $0.00 $0.00 MS300 DRG MS300 PERIPHERAL VASCULAR DISORDERS WITH CC INPATIENT ONLY "$33,127.53" "$24,514.37" $0.00 "$48,648.19" "$48,648.19" "$48,648.19" "$18,257.24" "$18,257.24" "$8,720.44" $0.00 $0.00 $0.00 "$6,696.82" "$18,238.60" $0.00 "$18,622.38" "$15,657.00" "$15,657.00" "$20,824.93" $0.00 $0.00 $0.00 $0.00 "$15,657.00" $0.00 "$9,354.11" "$21,537.17" "$21,537.17" "$19,833.27" "$9,821.82" $0.00 $0.00 $0.00 $0.00 MS301 DRG MS301 PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC INPATIENT ONLY "$26,808.70" "$19,838.44" $0.00 "$18,762.52" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$18,762.52" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$17,869.07" $0.00 $0.00 $0.00 $0.00 $0.00 MS302 DRG MS302 ATHEROSCLEROSIS WITH MCC INPATIENT ONLY "$27,989.74" "$20,712.41" $0.00 "$22,147.21" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$18,981.41" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$22,147.21" "$22,147.21" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS303 DRG MS303 ATHEROSCLEROSIS WITHOUT MCC INPATIENT ONLY "$9,872.00" "$7,305.28" $0.00 "$18,663.40" "$8,245.79" "$8,245.79" $0.00 $0.00 "$5,445.59" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$10,164.00" "$10,164.00" "$18,420.15" $0.00 $0.00 $0.00 $0.00 "$10,164.00" $0.00 $0.00 "$18,663.40" "$18,663.40" "$17,543.00" $0.00 $0.00 $0.00 $0.00 $0.00 MS304 DRG MS304 HYPERTENSION WITH MCC INPATIENT ONLY "$53,951.20" "$39,923.89" $0.00 "$22,059.01" $0.00 $0.00 "$18,624.42" "$18,624.42" $0.00 $0.00 $0.00 $0.00 $0.00 "$18,604.83" $0.00 "$18,996.91" $0.00 $0.00 "$21,261.62" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$22,059.01" "$22,059.01" "$20,249.16" $0.00 $0.00 $0.00 $0.00 $0.00 MS305 DRG MS305 HYPERTENSION WITHOUT MCC INPATIENT ONLY "$25,501.90" "$18,871.41" $0.00 "$19,723.81" "$16,899.41" "$16,899.41" "$16,589.44" "$16,589.44" "$5,598.22" $0.00 $0.00 $0.00 "$3,348.41" "$16,146.66" $0.00 "$16,765.12" "$11,098.50" "$11,098.50" "$12,322.90" "$3,994.80" "$19,723.81" $0.00 "$7,332.77" "$11,098.50" "$7,332.77" $0.00 "$19,119.10" "$19,119.10" "$12,322.90" $0.00 $0.00 $0.00 $0.00 $0.00 MS306 DRG MS306 CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC INPATIENT ONLY "$21,558.58" "$15,953.35" $0.00 "$21,885.92" $0.00 $0.00 "$21,456.78" "$21,456.78" $0.00 $0.00 $0.00 $0.00 $0.00 "$21,458.56" $0.00 "$21,885.92" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS307 DRG MS307 CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC INPATIENT ONLY "$33,309.85" "$24,649.29" $0.00 "$20,349.78" "$4,312.35" "$4,312.35" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$20,349.78" "$20,349.78" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS308 DRG MS308 CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC INPATIENT ONLY "$49,289.07" "$36,473.91" $0.00 "$23,133.27" "$4,086.60" "$4,086.60" "$19,341.47" "$19,341.47" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$23,133.27" $0.00 $0.00 "$21,919.03" "$3,891.70" "$14,418.05" $0.00 "$11,905.86" $0.00 "$11,905.86" $0.00 "$22,844.63" "$22,844.63" "$20,875.27" $0.00 $0.00 $0.00 $0.00 $0.00 MS309 DRG MS309 CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC INPATIENT ONLY "$32,971.70" "$24,399.06" $0.00 "$19,321.62" $0.00 $0.00 "$16,233.04" "$16,233.04" $0.00 $0.00 $0.00 $0.00 "$7,290.56" $0.00 $0.00 "$16,557.70" $0.00 $0.00 "$18,970.96" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$19,321.62" "$19,321.62" "$18,067.58" $0.00 $0.00 $0.00 $0.00 $0.00 MS310 DRG MS310 CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC INPATIENT ONLY "$26,112.51" "$19,323.26" $0.00 "$22,828.20" "$4,086.60" "$4,086.60" "$14,912.79" "$14,912.79" "$4,902.90" "$5,253.92" $0.00 $0.00 "$6,255.35" "$14,902.81" "$5,516.62" "$15,211.05" "$8,388.00" "$8,388.00" "$17,624.69" "$3,748.58" "$22,828.20" $0.00 "$5,606.59" "$8,388.00" "$5,606.59" "$3,051.09" "$17,712.81" "$17,712.81" "$16,785.42" "$3,247.21" $0.00 $0.00 $0.00 $0.00 MS311 DRG MS311 ANGINA PECTORIS INPATIENT ONLY "$52,330.57" "$38,724.62" $0.00 "$16,191.63" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$16,191.63" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS312 DRG MS312 SYNCOPE AND COLLAPSE INPATIENT ONLY "$61,214.52" "$45,298.74" $0.00 "$21,765.49" "$8,863.70" "$8,863.70" "$16,841.76" "$16,841.76" $0.00 $0.00 $0.00 $0.00 $0.00 "$16,826.78" $0.00 "$17,178.60" $0.00 $0.00 "$19,383.03" $0.00 $0.00 "$21,765.49" $0.00 $0.00 $0.00 "$6,911.00" "$19,814.06" "$19,814.06" "$18,460.03" "$7,256.54" $0.00 $0.00 $0.00 $0.00 MS313 DRG MS313 CHEST PAIN INPATIENT ONLY "$33,212.42" "$24,577.19" $0.00 "$18,986.78" $0.00 $0.00 "$16,032.21" "$16,032.21" $0.00 $0.00 $0.00 $0.00 $0.00 "$16,019.33" $0.00 "$16,352.85" $0.00 $0.00 "$18,707.26" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$18,986.78" "$18,986.78" "$17,816.56" $0.00 $0.00 $0.00 $0.00 $0.00 MS314 DRG MS314 OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC INPATIENT ONLY "$76,851.46" "$56,870.08" $0.00 "$90,518.61" $0.00 $0.00 "$25,441.03" "$25,441.03" $0.00 $0.00 $0.00 $0.00 $0.00 "$25,403.80" $0.00 "$25,949.85" $0.00 $0.00 "$27,671.68" "$27,623.06" "$90,518.61" $0.00 "$20,344.32" $0.00 "$20,344.32" $0.00 "$29,719.16" "$29,719.16" "$26,353.98" $0.00 $0.00 $0.00 $0.00 $0.00 MS315 DRG MS315 OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC INPATIENT ONLY "$25,527.92" "$18,890.66" $0.00 "$54,485.36" "$54,485.36" "$54,485.36" "$17,791.75" "$17,791.75" "$8,580.30" $0.00 $0.00 $0.00 "$10,045.23" $0.00 $0.00 "$18,126.81" "$14,601.00" "$14,601.00" "$20,434.06" $0.00 $0.00 $0.00 $0.00 "$14,601.00" $0.00 "$9,679.17" "$21,070.06" "$21,070.06" "$19,461.01" "$10,301.36" $0.00 $0.00 $0.00 $0.00 MS316 DRG MS316 OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC INPATIENT ONLY "$10,452.75" "$7,735.04" $0.00 "$56,774.44" $0.00 $0.00 "$16,046.01" "$16,046.01" $0.00 $0.00 $0.00 $0.00 "$10,604.42" $0.00 $0.00 "$16,366.93" $0.00 $0.00 $0.00 "$10,943.74" "$56,774.44" $0.00 "$7,440.03" $0.00 "$7,440.03" $0.00 "$19,206.47" "$19,206.47" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS326 DRG MS326 "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC" INPATIENT ONLY "$251,818.24" "$186,345.50" $0.00 "$291,990.40" "$291,990.40" "$291,990.40" "$47,743.90" "$47,743.90" $0.00 $0.00 $0.00 $0.00 "$112,752.12" "$47,648.96" $0.00 "$48,698.78" $0.00 $0.00 "$49,819.86" "$125,184.57" "$152,532.58" $0.00 "$52,833.10" $0.00 "$52,833.10" $0.00 "$74,365.49" "$74,365.49" "$47,447.49" $0.00 $0.00 $0.00 $0.00 $0.00 MS327 DRG MS327 "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC" INPATIENT ONLY "$345,047.66" "$255,335.27" $0.00 "$181,704.09" "$181,704.09" "$181,704.09" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$31,385.13" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$34,156.81" "$34,156.81" "$29,890.60" $0.00 $0.00 $0.00 $0.00 $0.00 MS328 DRG MS328 "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC" INPATIENT ONLY "$223,193.30" "$165,163.04" $0.00 "$94,605.75" $0.00 $0.00 "$22,557.58" "$22,557.58" $0.00 $0.00 $0.00 $0.00 "$33,357.43" "$22,527.81" $0.00 "$23,008.73" $0.00 $0.00 $0.00 $0.00 $0.00 "$94,605.75" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS329 DRG MS329 MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC INPATIENT ONLY "$274,008.89" "$202,766.58" $0.00 "$350,555.03" "$136,237.60" "$136,237.60" "$44,775.57" "$44,775.57" "$114,248.26" "$46,129.16" $0.00 $0.00 "$88,406.87" "$44,688.31" "$46,129.16" "$45,671.08" "$350,555.03" "$350,555.03" "$47,337.16" "$119,188.76" "$145,226.91" $0.00 "$49,191.26" "$350,555.03" "$49,191.26" "$44,151.78" "$53,219.79" "$53,219.79" "$45,083.01" "$46,359.35" $0.00 $0.00 $0.00 $0.00 MS330 DRG MS330 MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC INPATIENT ONLY "$213,414.08" "$157,926.42" $0.00 "$229,756.74" "$229,756.74" "$229,756.74" "$28,647.46" "$28,647.46" $0.00 $0.00 $0.00 $0.00 "$96,654.18" "$28,601.93" $0.00 "$29,220.41" $0.00 $0.00 "$31,070.11" "$108,768.24" "$132,529.93" $0.00 "$25,329.40" $0.00 "$25,329.40" $0.00 "$33,780.33" "$33,780.33" "$29,590.58" $0.00 $0.00 $0.00 $0.00 $0.00 MS331 DRG MS331 MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$192,463.33" "$142,422.86" $0.00 "$148,688.87" "$107,640.79" "$107,640.79" "$30,696.66" "$30,696.66" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$23,315.65" $0.00 $0.00 "$25,346.16" "$122,030.00" "$148,688.87" $0.00 "$16,933.05" $0.00 "$16,933.05" "$15,266.31" "$26,940.12" "$26,940.12" "$24,139.20" "$16,029.62" $0.00 $0.00 $0.00 $0.00 MS332 DRG MS332 RECTAL RESECTION WITH MCC INPATIENT ONLY "$887,584.06" "$656,812.20" $0.00 "$103,355.68" $0.00 $0.00 "$103,349.75" "$103,349.75" $0.00 $0.00 $0.00 $0.00 $0.00 "$103,355.68" $0.00 "$64,185.57" $0.00 $0.00 "$90,845.74" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$86,519.75" $0.00 $0.00 $0.00 $0.00 $0.00 MS333 DRG MS333 RECTAL RESECTION WITH CC INPATIENT ONLY "$620,492.87" "$459,164.72" $0.00 "$65,011.79" $0.00 $0.00 "$65,011.79" "$65,011.79" $0.00 $0.00 $0.00 $0.00 $0.00 "$65,006.35" $0.00 $0.00 $0.00 $0.00 "$56,104.18" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$53,432.55" $0.00 $0.00 $0.00 $0.00 $0.00 MS335 DRG MS335 PERITONEAL ADHESIOLYSIS WITH MCC INPATIENT ONLY "$532,766.31" "$394,247.07" $0.00 "$110,895.56" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$91,012.77" "$110,895.56" $0.00 "$40,549.32" $0.00 "$40,549.32" $0.00 "$46,179.48" "$46,179.48" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS336 DRG MS336 PERITONEAL ADHESIOLYSIS WITH CC INPATIENT ONLY "$219,777.95" "$162,635.68" $0.00 "$31,652.16" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$29,289.24" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$31,652.16" "$31,652.16" "$27,894.51" $0.00 $0.00 $0.00 $0.00 $0.00 MS337 DRG MS337 PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC INPATIENT ONLY "$186,895.48" "$138,302.66" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS338 DRG MS338 APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC INPATIENT ONLY "$181,523.85" "$134,327.65" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS339 DRG MS339 APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH CC INPATIENT ONLY "$125,577.54" "$92,927.38" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS340 DRG MS340 APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC INPATIENT ONLY "$100,873.09" "$74,646.09" $0.00 "$86,067.33" "$86,067.33" "$86,067.33" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$48,704.12" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS341 DRG MS341 APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC INPATIENT ONLY "$126,465.33" "$93,584.34" $0.00 "$36,751.27" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$31,284.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$36,751.27" $0.00 $0.00 $0.00 $0.00 $0.00 MS342 DRG MS342 APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH CC INPATIENT ONLY "$99,896.38" "$73,923.32" $0.00 "$75,672.75" "$4,542.21" "$4,542.21" $0.00 $0.00 "$11,703.42" $0.00 $0.00 $0.00 "$3,348.41" $0.00 $0.00 $0.00 "$75,672.75" "$75,672.75" $0.00 "$5,521.83" "$60,127.78" $0.00 "$16,142.14" "$75,672.75" "$16,142.14" $0.00 "$26,295.79" "$26,295.79" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS343 DRG MS343 APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC INPATIENT ONLY "$99,694.46" "$73,773.90" $0.00 "$70,753.35" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$3,348.41" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$7,075.14" "$70,753.35" "$58,511.81" "$11,543.98" $0.00 "$11,543.98" $0.00 "$22,549.80" "$22,549.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS344 DRG MS344 MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC INPATIENT ONLY "$63,631.33" "$47,087.18" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS345 DRG MS345 MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC INPATIENT ONLY "$164,994.22" "$122,095.72" $0.00 "$22,388.55" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$22,388.55" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS346 DRG MS346 MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$74,406.10" "$55,060.51" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS347 DRG MS347 ANAL AND STOMAL PROCEDURES WITH MCC INPATIENT ONLY "$26,552.02" "$19,648.49" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS348 DRG MS348 ANAL AND STOMAL PROCEDURES WITH CC INPATIENT ONLY "$83,349.83" "$61,678.87" $0.00 "$24,654.33" $0.00 $0.00 $0.00 $0.00 $0.00 "$16,830.84" $0.00 $0.00 $0.00 $0.00 "$23,744.82" $0.00 $0.00 $0.00 "$23,433.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$24,654.33" "$24,654.33" "$22,317.52" $0.00 $0.00 $0.00 $0.00 $0.00 MS349 DRG MS349 ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$65,922.10" "$48,782.35" $0.00 "$40,375.68" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$18,168.36" $0.00 $0.00 $0.00 "$6,026.40" "$40,375.68" $0.00 "$9,832.84" $0.00 "$9,832.84" $0.00 "$21,155.80" "$21,155.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS350 DRG MS350 INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC INPATIENT ONLY "$281,616.81" "$208,396.44" $0.00 "$30,472.16" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$30,472.16" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$29,021.10" $0.00 $0.00 $0.00 $0.00 $0.00 MS351 DRG MS351 INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC INPATIENT ONLY "$141,041.73" "$104,370.88" $0.00 "$114,048.28" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$93,600.21" "$114,048.28" $0.00 "$14,618.44" $0.00 "$14,618.44" $0.00 "$25,054.47" "$25,054.47" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS352 DRG MS352 INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$80,949.32" "$59,902.50" $0.00 "$120,426.90" "$120,426.90" "$120,426.90" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$21,938.97" "$21,938.97" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS353 DRG MS353 HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC INPATIENT ONLY "$250,528.06" "$185,390.76" $0.00 "$77,604.07" $0.00 $0.00 "$31,929.81" "$31,929.81" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$34,077.63" "$5,681.42" "$77,604.07" $0.00 "$29,741.12" $0.00 "$29,741.12" $0.00 "$37,374.40" "$37,374.40" "$32,454.89" $0.00 $0.00 $0.00 $0.00 $0.00 MS354 DRG MS354 HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC INPATIENT ONLY "$283,035.02" "$209,445.91" $0.00 "$101,424.28" "$101,424.28" "$101,424.28" "$23,371.27" "$23,371.27" $0.00 $0.00 $0.00 $0.00 "$53,576.10" "$23,339.39" $0.00 "$23,838.70" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$27,208.78" "$27,208.78" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS355 DRG MS355 HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC INPATIENT ONLY "$131,335.21" "$97,188.06" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS356 DRG MS356 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC INPATIENT ONLY "$231,882.30" "$171,592.90" $0.00 "$46,441.63" $0.00 $0.00 "$40,783.74" "$40,783.74" $0.00 $0.00 $0.00 $0.00 $0.00 "$40,706.81" $0.00 "$41,599.41" $0.00 $0.00 "$39,681.10" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$46,441.63" "$46,441.63" "$39,681.10" $0.00 $0.00 $0.00 $0.00 $0.00 MS357 DRG MS357 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC INPATIENT ONLY "$246,036.70" "$182,067.16" $0.00 "$27,791.66" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$26,669.02" $0.00 $0.00 $0.00 $0.00 "$27,791.66" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$27,791.66" $0.00 $0.00 $0.00 $0.00 $0.00 MS358 DRG MS358 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$305,696.80" "$226,215.63" $0.00 "$66,333.91" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$5,778.35" "$66,333.91" $0.00 "$13,749.33" $0.00 "$13,749.33" $0.00 "$24,346.43" "$24,346.43" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS368 DRG MS368 MAJOR ESOPHAGEAL DISORDERS WITH MCC INPATIENT ONLY "$44,626.39" "$33,023.53" $0.00 "$28,691.00" "$17,417.13" "$17,417.13" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$18,857.51" $0.00 $0.00 $0.00 "$4,678.10" "$21,077.61" $0.00 "$19,082.27" $0.00 "$19,082.27" $0.00 "$28,691.00" "$28,691.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS369 DRG MS369 MAJOR ESOPHAGEAL DISORDERS WITH CC INPATIENT ONLY "$33,210.98" "$24,576.13" $0.00 "$21,827.08" $0.00 $0.00 "$18,487.75" "$18,487.75" $0.00 $0.00 $0.00 $0.00 $0.00 "$18,468.52" $0.00 "$18,857.51" $0.00 $0.00 $0.00 "$8,473.19" "$17,181.21" $0.00 "$10,656.83" $0.00 "$10,656.83" $0.00 "$21,827.08" "$21,827.08" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS370 DRG MS370 MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC INPATIENT ONLY "$70,028.29" "$51,820.93" $0.00 "$9,760.80" "$9,760.80" "$9,760.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS371 DRG MS371 MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC INPATIENT ONLY "$90,719.83" "$67,132.67" $0.00 "$27,236.55" $0.00 $0.00 "$23,001.33" "$23,001.33" $0.00 $0.00 $0.00 $0.00 $0.00 "$22,970.42" $0.00 "$23,461.36" $0.00 $0.00 "$25,594.22" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$27,236.55" "$27,236.55" "$24,375.45" $0.00 $0.00 $0.00 $0.00 $0.00 MS372 DRG MS372 MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC INPATIENT ONLY "$41,041.65" "$30,370.82" $0.00 "$21,495.52" $0.00 $0.00 "$18,157.17" "$18,157.17" $0.00 "$3,697.23" $0.00 $0.00 $0.00 "$18,138.79" "$9,522.34" "$18,520.31" $0.00 $0.00 "$20,790.09" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$21,495.52" "$21,495.52" "$19,800.09" $0.00 $0.00 $0.00 $0.00 $0.00 MS373 DRG MS373 MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC INPATIENT ONLY "$25,826.81" "$19,111.84" $0.00 "$18,871.86" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$18,871.86" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$17,973.20" $0.00 $0.00 $0.00 $0.00 $0.00 MS374 DRG MS374 DIGESTIVE MALIGNANCY WITH MCC INPATIENT ONLY "$130,953.52" "$96,905.60" $0.00 "$103,204.32" "$8,173.20" "$8,173.20" "$25,365.10" "$25,365.10" $0.00 $0.00 $0.00 $0.00 $0.00 "$25,328.06" $0.00 "$25,872.40" $0.00 $0.00 "$27,453.01" $0.00 $0.00 "$103,204.32" $0.00 $0.00 $0.00 $0.00 "$25,228.00" "$25,228.00" "$26,145.72" $0.00 $0.00 $0.00 $0.00 $0.00 MS375 DRG MS375 DIGESTIVE MALIGNANCY WITH CC INPATIENT ONLY "$43,263.16" "$32,014.74" $0.00 "$23,004.69" $0.00 $0.00 "$19,387.71" "$19,387.71" $0.00 $0.00 $0.00 $0.00 $0.00 "$19,366.15" $0.00 "$19,775.46" $0.00 $0.00 "$22,052.97" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$23,004.69" "$23,004.69" "$21,002.83" $0.00 $0.00 $0.00 $0.00 $0.00 MS376 DRG MS376 DIGESTIVE MALIGNANCY WITHOUT CC/MCC INPATIENT ONLY "$50,921.70" "$37,682.06" $0.00 "$20,645.23" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$17,241.18" $0.00 "$17,602.37" $0.00 $0.00 "$20,645.23" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$19,662.12" $0.00 $0.00 $0.00 $0.00 $0.00 MS377 DRG MS377 GASTROINTESTINAL HEMORRHAGE WITH MCC INPATIENT ONLY "$78,283.67" "$57,929.92" $0.00 "$56,749.25" "$20,646.76" "$20,646.76" "$23,484.44" "$23,484.44" $0.00 "$15,384.27" $0.00 $0.00 $0.00 "$23,452.27" "$15,384.27" "$23,954.13" $0.00 $0.00 "$25,897.63" $0.00 $0.00 "$56,749.25" $0.00 $0.00 $0.00 $0.00 "$27,599.14" "$27,599.14" "$24,664.41" $0.00 $0.00 $0.00 $0.00 $0.00 MS378 DRG MS378 GASTROINTESTINAL HEMORRHAGE WITH CC INPATIENT ONLY "$34,470.23" "$25,507.97" $0.00 "$34,384.78" "$17,023.65" "$17,023.65" "$17,910.11" "$17,910.11" $0.00 $0.00 $0.00 $0.00 $0.00 "$17,892.36" $0.00 "$18,268.31" $0.00 $0.00 "$19,576.19" "$14,569.53" "$34,384.78" $0.00 "$9,905.01" $0.00 "$9,905.01" "$8,932.14" "$21,214.59" "$21,214.59" "$19,576.19" "$9,378.74" $0.00 $0.00 $0.00 $0.00 MS379 DRG MS379 GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC INPATIENT ONLY "$37,486.96" "$27,740.35" $0.00 "$18,418.41" "$8,963.57" "$8,963.57" "$15,451.11" "$15,451.11" "$6,048.07" $0.00 $0.00 $0.00 "$10,935.84" "$15,439.72" $0.00 "$15,760.13" "$9,558.00" "$9,558.00" "$18,215.14" $0.00 $0.00 $0.00 $0.00 "$9,558.00" $0.00 $0.00 "$18,418.41" "$18,418.41" "$17,347.75" $0.00 $0.00 $0.00 $0.00 $0.00 MS380 DRG MS380 COMPLICATED PEPTIC ULCER WITH MCC INPATIENT ONLY "$26,794.24" "$19,827.74" $0.00 "$194,237.98" $0.00 $0.00 "$29,530.88" "$29,530.88" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$24,555.31" $0.00 $0.00 $0.00 "$159,412.49" "$194,237.98" $0.00 "$24,569.41" $0.00 "$24,569.41" $0.00 "$28,560.33" "$28,560.33" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS381 DRG MS381 COMPLICATED PEPTIC ULCER WITH CC INPATIENT ONLY "$46,100.59" "$34,114.44" $0.00 "$21,938.15" "$8,173.20" "$8,173.20" "$18,364.22" "$18,364.22" $0.00 $0.00 $0.00 $0.00 "$13,393.64" $0.00 $0.00 "$18,731.50" $0.00 $0.00 "$21,160.49" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$21,938.15" "$21,938.15" "$20,152.85" $0.00 $0.00 $0.00 $0.00 $0.00 MS382 DRG MS382 COMPLICATED PEPTIC ULCER WITHOUT CC/MCC INPATIENT ONLY "$31,452.30" "$23,274.70" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS383 DRG MS383 UNCOMPLICATED PEPTIC ULCER WITH MCC INPATIENT ONLY "$24,431.24" "$18,079.12" $0.00 "$23,976.51" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$23,976.51" "$23,976.51" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS384 DRG MS384 UNCOMPLICATED PEPTIC ULCER WITHOUT MCC INPATIENT ONLY "$33,274.53" "$24,623.15" $0.00 "$26,787.28" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$26,787.28" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS385 DRG MS385 INFLAMMATORY BOWEL DISEASE WITH MCC INPATIENT ONLY "$67,760.04" "$50,142.43" $0.00 "$24,806.99" $0.00 $0.00 "$22,249.76" "$22,249.76" $0.00 $0.00 $0.00 $0.00 $0.00 "$22,220.79" $0.00 "$22,694.76" $0.00 $0.00 "$24,806.99" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$23,625.70" $0.00 $0.00 $0.00 $0.00 $0.00 MS386 DRG MS386 INFLAMMATORY BOWEL DISEASE WITH CC INPATIENT ONLY "$56,023.07" "$41,457.07" $0.00 "$21,190.92" "$20,433.00" "$20,433.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$6,696.82" $0.00 $0.00 $0.00 $0.00 $0.00 "$20,535.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$21,190.92" "$21,190.92" "$19,557.33" $0.00 $0.00 $0.00 $0.00 $0.00 MS387 DRG MS387 INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC INPATIENT ONLY "$23,208.03" "$17,173.94" $0.00 "$16,305.69" $0.00 $0.00 "$15,985.97" "$15,985.97" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$16,305.69" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS388 DRG MS388 GASTROINTESTINAL OBSTRUCTION WITH MCC INPATIENT ONLY "$77,758.35" "$57,541.18" $0.00 "$25,918.43" "$25,918.43" "$25,918.43" "$21,506.47" "$21,506.47" $0.00 $0.00 $0.00 $0.00 $0.00 "$21,479.43" $0.00 "$21,936.60" $0.00 $0.00 "$24,224.74" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$25,599.99" "$25,599.99" "$23,071.18" $0.00 $0.00 $0.00 $0.00 $0.00 MS389 DRG MS389 GASTROINTESTINAL OBSTRUCTION WITH CC INPATIENT ONLY "$39,413.46" "$29,165.96" $0.00 "$20,002.70" $0.00 $0.00 "$16,734.77" "$16,734.77" $0.00 $0.00 $0.00 $0.00 $0.00 "$16,720.07" $0.00 "$17,069.47" $0.00 $0.00 "$19,540.89" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$20,002.70" "$20,002.70" "$18,610.37" $0.00 $0.00 $0.00 $0.00 $0.00 MS390 DRG MS390 GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC INPATIENT ONLY "$29,912.81" "$22,135.48" $0.00 "$95,740.02" "$95,740.02" "$95,740.02" "$15,077.74" "$15,077.74" $0.00 "$5,565.81" $0.00 $0.00 "$3,348.41" "$15,067.32" "$5,565.81" "$15,379.29" $0.00 $0.00 "$17,763.43" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$5,327.23" $0.00 $0.00 "$16,917.55" "$5,593.59" $0.00 $0.00 $0.00 $0.00 MS391 DRG MS391 "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC" INPATIENT ONLY "$41,863.55" "$30,979.03" $0.00 "$23,230.90" $0.00 $0.00 "$19,674.82" "$19,674.82" $0.00 $0.00 $0.00 $0.00 $0.00 "$19,652.52" $0.00 "$20,068.32" $0.00 $0.00 "$22,242.27" "$7,432.68" "$17,525.21" $0.00 "$12,380.02" $0.00 "$12,380.02" $0.00 "$23,230.90" "$23,230.90" "$21,183.11" $0.00 $0.00 $0.00 $0.00 $0.00 MS392 DRG MS392 "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC" INPATIENT ONLY "$33,170.14" "$24,545.90" $0.00 "$41,242.74" "$12,630.39" "$12,630.39" "$16,338.64" "$16,338.64" $0.00 "$2,286.70" $0.00 $0.00 "$6,696.82" $0.00 "$7,045.49" "$16,665.41" $0.00 $0.00 "$19,006.49" "$11,228.32" "$41,242.74" "$23,420.75" "$7,633.51" $0.00 "$7,633.51" "$4,002.23" "$19,364.08" "$19,364.08" "$18,101.42" "$4,259.49" $0.00 $0.00 $0.00 $0.00 MS393 DRG MS393 OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC INPATIENT ONLY "$50,282.24" "$37,208.86" $0.00 "$26,411.73" "$16,829.88" "$16,829.88" "$22,518.23" "$22,518.23" "$15,078.24" $0.00 $0.00 $0.00 $0.00 "$22,488.57" $0.00 "$22,968.59" "$20,121.93" "$20,121.93" "$24,904.01" $0.00 $0.00 $0.00 $0.00 "$20,121.93" $0.00 $0.00 "$26,411.73" "$26,411.73" "$23,718.10" $0.00 $0.00 $0.00 $0.00 $0.00 MS394 DRG MS394 OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC INPATIENT ONLY "$43,731.97" "$32,361.66" $0.00 "$21,956.06" $0.00 $0.00 "$17,547.08" "$17,547.08" $0.00 $0.00 $0.00 $0.00 "$13,393.64" "$17,530.28" $0.00 "$17,898.02" $0.00 $0.00 "$20,213.34" "$7,280.15" "$21,956.06" $0.00 "$9,403.81" $0.00 "$9,403.81" "$5,243.56" "$20,806.29" "$20,806.29" "$19,250.80" "$5,580.62" $0.00 $0.00 $0.00 $0.00 MS395 DRG MS395 OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC INPATIENT ONLY "$22,243.70" "$16,460.34" $0.00 "$24,982.77" "$24,982.77" "$24,982.77" "$15,549.79" "$15,549.79" "$5,867.77" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$16,327.28" "$9,772.50" "$9,772.50" $0.00 "$7,147.50" "$12,116.27" $0.00 "$6,559.90" "$9,772.50" "$6,559.90" "$4,462.69" "$18,489.46" "$18,489.46" $0.00 "$4,749.55" $0.00 $0.00 $0.00 $0.00 MS405 DRG MS405 "PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC" INPATIENT ONLY "$200,263.23" "$148,194.79" $0.00 "$50,890.72" $0.00 $0.00 "$50,651.50" "$50,651.50" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$50,890.72" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$48,467.35" $0.00 $0.00 $0.00 $0.00 $0.00 MS406 DRG MS406 "PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC" INPATIENT ONLY "$83,962.91" "$62,132.55" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS407 DRG MS407 "PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC" INPATIENT ONLY "$379,474.22" "$280,810.92" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS408 DRG MS408 BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC INPATIENT ONLY "$436,154.41" "$322,754.26" $0.00 "$50,500.02" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$50,500.02" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS410 DRG MS410 BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC INPATIENT ONLY "$300,972.34" "$222,719.53" $0.00 "$201,119.77" "$193,135.50" "$193,135.50" $0.00 $0.00 "$49,341.28" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$195,549.45" "$195,549.45" $0.00 "$165,060.42" "$201,119.77" $0.00 "$26,144.96" "$195,549.45" "$26,144.96" $0.00 "$26,701.64" "$26,701.64" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS414 DRG MS414 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC INPATIENT ONLY "$156,040.59" "$115,470.04" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS415 DRG MS415 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC INPATIENT ONLY "$136,109.70" "$100,721.18" $0.00 "$120,290.03" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$98,722.88" "$120,290.03" $0.00 "$20,566.86" $0.00 "$20,566.86" $0.00 "$29,900.46" "$29,900.46" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS416 DRG MS416 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC INPATIENT ONLY "$292,085.37" "$216,143.17" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS417 DRG MS417 LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC INPATIENT ONLY "$137,676.65" "$101,880.72" $0.00 "$146,623.60" $0.00 $0.00 $0.00 $0.00 $0.00 "$21,096.73" $0.00 $0.00 "$44,529.93" $0.00 "$21,096.73" $0.00 $0.00 $0.00 "$30,276.71" "$120,335.03" "$146,623.60" $0.00 "$24,165.59" $0.00 "$24,165.59" $0.00 "$32,832.21" "$32,832.21" "$28,834.96" $0.00 $0.00 $0.00 $0.00 $0.00 MS418 DRG MS418 LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC INPATIENT ONLY "$146,973.04" "$108,760.05" $0.00 "$84,039.69" "$84,039.69" "$84,039.69" "$22,710.10" "$22,710.10" $0.00 "$28,650.88" $0.00 $0.00 $0.00 $0.00 "$28,651.56" "$23,164.30" $0.00 $0.00 "$25,207.41" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$24,007.06" $0.00 $0.00 $0.00 $0.00 $0.00 MS419 DRG MS419 LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC INPATIENT ONLY "$132,793.00" "$98,266.82" $0.00 "$104,723.37" "$91,322.65" "$91,322.65" $0.00 $0.00 "$12,698.94" "$10,708.77" $0.00 $0.00 $0.00 $0.00 "$11,244.21" $0.00 "$92,670.16" "$92,670.16" "$22,732.94" "$85,947.21" "$104,723.37" "$67,774.35" "$13,099.76" "$92,670.16" "$13,099.76" "$10,762.21" "$23,817.26" "$23,817.26" "$21,650.42" "$11,300.32" $0.00 $0.00 $0.00 $0.00 MS420 DRG MS420 HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC INPATIENT ONLY "$138,545.38" "$102,523.58" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS423 DRG MS423 OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC INPATIENT ONLY "$287,776.74" "$212,954.79" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS432 DRG MS432 CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC INPATIENT ONLY "$71,759.88" "$53,102.31" $0.00 "$28,036.05" "$8,624.70" "$8,624.70" "$24,159.76" "$24,159.76" $0.00 $0.00 $0.00 $0.00 $0.00 "$24,000.21" $0.00 $784.10 $0.00 $0.00 "$26,263.25" "$17,070.50" "$27,475.36" $0.00 "$18,278.31" $0.00 "$18,278.31" $0.00 "$28,036.05" "$28,036.05" "$25,012.62" $0.00 $0.00 $0.00 $0.00 $0.00 MS433 DRG MS433 CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC INPATIENT ONLY "$45,714.27" "$33,828.56" $0.00 "$29,212.66" "$4,086.60" "$4,086.60" "$18,161.31" "$18,161.31" "$8,187.57" $0.00 $0.00 $0.00 "$13,393.64" "$18,142.93" $0.00 "$18,524.54" "$15,448.50" "$15,448.50" "$20,855.02" "$14,492.23" "$29,212.66" $0.00 "$10,345.09" "$15,448.50" "$10,345.09" $0.00 "$21,573.12" "$21,573.12" "$19,861.92" $0.00 $0.00 $0.00 $0.00 $0.00 MS434 DRG MS434 CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC INPATIENT ONLY "$20,195.51" "$14,944.68" $0.00 "$18,175.50" "$4,086.60" "$4,086.60" $0.00 $0.00 $0.00 "$6,206.31" $0.00 $0.00 $0.00 "$15,326.14" "$6,206.31" $0.00 $0.00 $0.00 "$18,175.50" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$17,310.00" $0.00 $0.00 $0.00 $0.00 $0.00 MS435 DRG MS435 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC INPATIENT ONLY "$95,710.06" "$70,825.44" $0.00 "$27,004.64" "$13,847.40" "$13,847.40" "$23,154.55" "$23,154.55" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$23,617.64" $0.00 $0.00 "$25,400.15" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$27,004.64" "$27,004.64" "$24,190.62" $0.00 $0.00 $0.00 $0.00 $0.00 MS436 DRG MS436 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC INPATIENT ONLY "$52,499.34" "$38,849.51" $0.00 "$21,514.22" $0.00 $0.00 "$18,793.50" "$18,793.50" $0.00 $0.00 $0.00 $0.00 $0.00 "$18,773.47" $0.00 $0.00 $0.00 $0.00 "$21,514.22" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$20,489.83" $0.00 $0.00 $0.00 $0.00 $0.00 MS437 DRG MS437 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC INPATIENT ONLY "$67,843.68" "$50,204.32" $0.00 "$19,475.99" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$19,475.99" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$19,475.99" $0.00 $0.00 $0.00 $0.00 $0.00 MS438 DRG MS438 DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC INPATIENT ONLY "$45,592.09" "$33,738.15" $0.00 "$26,524.44" $0.00 $0.00 "$22,080.67" "$22,080.67" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$22,522.28" $0.00 $0.00 "$24,998.33" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$26,524.44" "$26,524.44" "$23,807.93" $0.00 $0.00 $0.00 $0.00 $0.00 MS439 DRG MS439 DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC INPATIENT ONLY "$35,242.46" "$26,079.42" $0.00 "$27,105.60" "$27,105.60" "$27,105.60" "$16,886.61" "$16,886.61" $0.00 "$8,501.51" $0.00 $0.00 $0.00 "$16,871.51" "$8,501.51" "$17,224.34" $0.00 $0.00 "$19,592.13" "$3,287.36" "$18,691.33" $0.00 "$8,492.59" $0.00 "$8,492.59" "$8,137.08" "$20,063.94" "$20,063.94" "$18,659.17" "$8,543.93" $0.00 $0.00 $0.00 $0.00 MS440 DRG MS440 DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC INPATIENT ONLY "$36,890.80" "$27,299.19" $0.00 "$8,173.20" "$8,173.20" "$8,173.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS441 DRG MS441 "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC" INPATIENT ONLY "$49,349.00" "$36,518.26" $0.00 "$236,480.96" $0.00 $0.00 "$24,024.82" "$24,024.82" $0.00 $0.00 $0.00 $0.00 "$236,480.96" $0.00 $0.00 "$29,751.07" $0.00 $0.00 "$26,532.44" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$19,575.49" "$19,575.49" "$26,532.44" $0.00 $0.00 $0.00 $0.00 $0.00 MS442 DRG MS442 "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC" INPATIENT ONLY "$39,164.06" "$28,981.40" $0.00 "$20,767.89" "$16,346.40" "$16,346.40" "$17,471.86" "$17,471.86" $0.00 $0.00 $0.00 $0.00 "$16,742.05" "$17,455.25" $0.00 $171.72 $0.00 $0.00 "$20,181.21" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$20,767.89" "$20,767.89" "$19,220.20" $0.00 $0.00 $0.00 $0.00 $0.00 MS443 DRG MS443 "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC" INPATIENT ONLY "$37,763.49" "$27,944.98" $0.00 "$38,930.80" "$12,711.30" "$12,711.30" "$15,630.55" "$15,630.55" "$5,812.44" $0.00 $0.00 $0.00 $0.00 "$15,618.70" $0.00 "$15,943.16" "$9,948.00" "$9,948.00" $0.00 "$10,031.02" "$38,930.80" $0.00 "$6,819.53" "$9,948.00" "$6,819.53" "$6,169.37" "$18,700.96" "$18,700.96" $0.00 "$6,477.83" $0.00 $0.00 $0.00 $0.00 MS444 DRG MS444 DISORDERS OF THE BILIARY TRACT WITH MCC INPATIENT ONLY "$40,567.37" "$30,019.85" $0.00 "$24,914.95" "$16,346.40" "$16,346.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$23,041.82" $0.00 $0.00 "$24,914.95" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$23,728.52" $0.00 $0.00 $0.00 $0.00 $0.00 MS445 DRG MS445 DISORDERS OF THE BILIARY TRACT WITH CC INPATIENT ONLY "$39,233.35" "$29,032.68" $0.00 "$21,920.18" $0.00 $0.00 "$18,489.83" "$18,489.83" $0.00 "$10,502.48" $0.00 $0.00 $0.00 $0.00 "$10,502.48" "$18,859.63" $0.00 $0.00 "$21,145.45" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$21,920.18" "$21,920.18" "$20,138.52" $0.00 $0.00 $0.00 $0.00 $0.00 MS446 DRG MS446 DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC INPATIENT ONLY "$46,325.27" "$34,280.70" $0.00 "$13,393.64" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$13,393.64" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS453 DRG MS453 COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC INPATIENT ONLY "$438,917.25" "$324,798.77" $0.00 "$236,554.02" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$236,554.02" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS454 DRG MS454 COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC INPATIENT ONLY "$407,718.97" "$301,712.04" $0.00 "$271,075.74" $0.00 $0.00 $0.00 $0.00 $0.00 "$104,673.75" $0.00 $0.00 "$271,075.74" $0.00 "$104,674.30" $0.00 $0.00 $0.00 "$55,659.30" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$63,264.79" "$63,164.90" "$63,164.90" "$53,008.86" "$50,919.68" $0.00 $0.00 $0.00 $0.00 MS455 DRG MS455 COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC INPATIENT ONLY "$334,789.12" "$247,743.95" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS456 DRG MS456 "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC" INPATIENT ONLY "$340,429.20" "$251,917.61" $0.00 "$71,814.47" $0.00 $0.00 "$70,406.34" "$70,406.34" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$71,814.47" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS457 DRG MS457 "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC" INPATIENT ONLY "$334,299.43" "$247,381.58" $0.00 "$69,502.94" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$69,502.94" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS459 DRG MS459 SPINAL FUSION EXCEPT CERVICAL WITH MCC INPATIENT ONLY "$590,788.39" "$437,183.41" $0.00 "$294,344.86" "$294,344.86" "$294,344.86" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$259,255.92" $0.00 $0.00 $0.00 $0.00 $0.00 "$60,627.44" "$173,392.23" "$211,271.76" $0.00 "$68,686.54" $0.00 "$68,686.54" $0.00 "$69,101.93" "$69,101.93" "$57,740.42" $0.00 $0.00 $0.00 $0.00 $0.00 MS460 DRG MS460 SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC INPATIENT ONLY "$243,368.62" "$180,092.78" $0.00 "$66,414.60" $0.00 $0.00 "$38,181.18" "$38,181.18" $0.00 "$49,968.85" $0.00 $0.00 $0.00 $0.00 "$66,414.60" "$38,944.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS463 DRG MS463 WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC INPATIENT ONLY "$340,239.14" "$251,776.96" $0.00 "$407,660.93" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$55,832.33" "$334,570.22" "$407,660.93" $0.00 "$94,279.70" $0.00 "$94,279.70" $0.00 "$55,837.96" "$55,837.96" "$53,173.65" $0.00 $0.00 $0.00 $0.00 $0.00 MS464 DRG MS464 WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC INPATIENT ONLY "$323,690.26" "$239,530.79" $0.00 "$146,335.63" "$115,976.76" "$115,976.76" "$31,591.63" "$31,591.63" $0.00 "$88,498.29" $0.00 $0.00 $0.00 $0.00 "$88,498.29" "$32,223.46" $0.00 $0.00 $0.00 "$120,098.69" "$146,335.63" $0.00 "$29,598.76" $0.00 "$29,598.76" "$27,265.48" "$37,258.44" "$37,258.44" $0.00 "$28,628.74" $0.00 $0.00 $0.00 $0.00 MS465 DRG MS465 WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC INPATIENT ONLY "$180,920.22" "$133,880.96" $0.00 "$117,446.30" "$101,350.92" "$101,350.92" $0.00 $0.00 "$23,618.90" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$117,446.30" "$117,446.30" $0.00 "$28,239.62" "$77,963.23" $0.00 "$19,198.54" "$117,446.30" "$19,198.54" "$13,287.73" "$28,785.73" "$28,785.73" $0.00 "$13,952.11" $0.00 $0.00 $0.00 $0.00 MS466 DRG MS466 REVISION OF HIP OR KNEE REPLACEMENT WITH MCC INPATIENT ONLY "$222,148.64" "$164,389.99" $0.00 "$54,786.94" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$54,786.94" "$54,786.94" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS467 DRG MS467 REVISION OF HIP OR KNEE REPLACEMENT WITH CC INPATIENT ONLY "$270,187.14" "$199,938.48" $0.00 "$41,826.76" $0.00 $0.00 "$35,743.58" "$35,743.58" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$36,458.45" $0.00 $0.00 "$37,803.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$41,826.76" "$41,826.76" "$36,003.24" $0.00 $0.00 $0.00 $0.00 $0.00 MS468 DRG MS468 REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC INPATIENT ONLY "$240,260.62" "$177,792.86" $0.00 "$36,110.24" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$36,110.24" "$36,110.24" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS469 DRG MS469 MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT INPATIENT ONLY "$181,244.35" "$134,120.82" $0.00 "$38,787.20" $0.00 $0.00 "$32,350.79" "$32,350.79" $0.00 $0.00 $0.00 $0.00 $0.00 "$32,295.68" $0.00 "$32,859.14" $0.00 $0.00 "$35,259.88" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$38,787.20" "$38,787.20" "$33,580.84" $0.00 $0.00 $0.00 $0.00 $0.00 MS470 DRG MS470 MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC INPATIENT ONLY "$140,929.21" "$104,287.62" $0.00 "$90,107.90" "$90,107.90" "$90,107.90" "$24,168.39" "$24,168.39" $0.00 $0.00 $0.00 $0.00 $0.00 "$24,134.45" $0.00 "$26,686.88" $0.00 $0.00 "$27,254.14" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$29,220.19" "$29,220.19" "$25,956.32" $0.00 $0.00 $0.00 $0.00 $0.00 MS471 DRG MS471 CERVICAL SPINAL FUSION WITH MCC INPATIENT ONLY "$357,681.21" "$264,684.10" $0.00 "$46,610.85" $0.00 $0.00 "$45,696.91" "$45,696.91" $0.00 $0.00 $0.00 $0.00 $0.00 "$45,607.28" $0.00 "$46,610.85" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS472 DRG MS472 CERVICAL SPINAL FUSION WITH CC INPATIENT ONLY "$261,184.95" "$193,276.86" $0.00 "$160,311.29" $0.00 $0.00 "$32,128.57" "$32,128.57" $0.00 "$97,395.39" $0.00 $0.00 $0.00 "$32,074.03" "$97,407.75" "$32,771.14" $0.00 $0.00 "$34,587.43" "$131,568.61" "$160,311.29" $0.00 "$30,488.93" $0.00 "$30,488.93" $0.00 "$37,983.62" "$37,983.62" "$32,940.41" $0.00 $0.00 $0.00 $0.00 $0.00 MS473 DRG MS473 CERVICAL SPINAL FUSION WITHOUT CC/MCC INPATIENT ONLY "$239,665.96" "$177,352.81" $0.00 "$107,627.95" "$99,766.44" "$99,766.44" "$28,576.36" "$28,576.36" $0.00 "$40,046.68" $0.00 $0.00 "$107,627.95" "$28,531.02" "$40,046.68" "$29,147.89" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS474 DRG MS474 AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC INPATIENT ONLY "$201,974.02" "$149,460.77" $0.00 "$40,282.68" $0.00 $0.00 "$39,184.68" "$39,184.68" $0.00 $0.00 $0.00 $0.00 $0.00 "$39,111.88" $0.00 "$39,968.37" $0.00 $0.00 "$40,282.68" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$38,364.46" $0.00 $0.00 $0.00 $0.00 $0.00 MS475 DRG MS475 AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC INPATIENT ONLY "$105,803.89" "$78,294.88" $0.00 "$326,501.77" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$28,160.30" "$267,962.31" "$326,501.77" $0.00 "$64,048.46" $0.00 "$64,048.46" $0.00 "$30,303.06" "$30,303.06" "$26,819.33" $0.00 $0.00 $0.00 $0.00 $0.00 MS476 DRG MS476 AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC INPATIENT ONLY "$108,051.26" "$79,957.93" $0.00 "$9,120.12" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$8,685.83" $0.00 $0.00 $0.00 "$9,120.12" $0.00 $0.00 $0.00 $0.00 MS477 DRG MS477 BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC INPATIENT ONLY "$61,538.76" "$45,538.68" $0.00 "$39,729.61" $0.00 $0.00 "$34,234.90" "$34,234.90" $0.00 $0.00 $0.00 $0.00 $0.00 "$34,174.93" $0.00 "$34,919.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$39,729.61" "$39,729.61" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS478 DRG MS478 BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC INPATIENT ONLY "$39,367.17" "$29,131.71" $0.00 "$224,555.14" "$217,556.76" "$217,556.76" $0.00 $0.00 "$61,408.69" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$224,555.14" "$224,555.14" "$29,637.06" $0.00 $0.00 $0.00 $0.00 "$224,555.14" $0.00 "$20,384.36" "$32,067.82" "$32,067.82" "$28,225.77" "$21,403.57" $0.00 $0.00 $0.00 $0.00 MS479 DRG MS479 BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC INPATIENT ONLY "$106,309.92" "$78,669.34" $0.00 "$71,699.35" $0.00 $0.00 $0.00 $0.00 "$15,452.22" "$15,243.66" $0.00 $0.00 $0.00 $0.00 "$20,028.55" $0.00 "$69,077.11" "$69,077.11" $0.00 "$18,769.33" "$71,699.35" $0.00 "$17,864.32" "$69,077.11" "$17,864.32" $0.00 "$27,698.78" "$27,698.78" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS480 DRG MS480 HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC INPATIENT ONLY "$243,911.55" "$180,494.55" $0.00 "$155,993.30" "$155,993.30" "$155,993.30" "$31,936.01" "$31,936.01" $0.00 "$68,695.36" $0.00 $0.00 "$113,747.24" "$31,881.99" "$68,695.36" "$32,574.73" $0.00 $0.00 "$34,430.27" "$117,923.11" "$143,684.76" $0.00 "$30,258.36" $0.00 "$30,258.36" $0.00 "$37,795.79" "$37,795.79" "$32,790.73" $0.00 $0.00 $0.00 $0.00 $0.00 MS481 DRG MS481 HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC INPATIENT ONLY "$187,285.44" "$138,591.23" $0.00 "$103,487.69" "$103,487.69" "$103,487.69" "$25,519.71" "$25,519.71" $0.00 "$34,406.15" $0.00 $0.00 "$69,006.41" "$25,482.27" "$44,024.27" "$26,030.10" $0.00 $0.00 "$28,070.09" "$19,240.38" "$68,283.40" "$91,568.13" "$20,928.74" $0.00 "$20,928.74" "$16,097.59" "$30,195.26" "$30,195.26" "$26,733.42" "$16,920.75" $0.00 $0.00 $0.00 $0.00 MS482 DRG MS482 HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC INPATIENT ONLY "$152,211.21" "$112,636.30" $0.00 "$106,385.28" "$106,385.28" "$106,385.28" "$22,411.96" "$22,411.96" "$94,795.46" "$28,317.96" $0.00 $0.00 "$10,396.95" "$22,382.56" "$21,211.70" "$22,860.20" "$94,795.46" "$94,795.46" "$25,046.15" "$20,216.62" "$82,311.01" "$82,947.32" "$16,492.99" "$94,795.46" "$16,492.99" "$15,016.39" "$26,581.60" "$26,581.60" "$23,853.48" "$15,767.20" $0.00 $0.00 $0.00 $0.00 MS483 DRG MS483 MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES INPATIENT ONLY "$217,236.63" "$160,755.11" $0.00 "$32,680.33" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$27,475.77" $0.00 $0.00 $0.00 $0.00 "$30,149.61" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$32,680.33" "$32,680.33" "$28,713.91" $0.00 $0.00 $0.00 $0.00 $0.00 MS485 DRG MS485 KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC INPATIENT ONLY "$181,169.09" "$134,065.13" $0.00 "$34,584.81" $0.00 $0.00 "$34,584.81" "$34,584.81" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS486 DRG MS486 KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC INPATIENT ONLY "$132,640.30" "$98,153.82" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS487 DRG MS487 KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC INPATIENT ONLY "$66,172.30" "$48,967.50" $0.00 "$24,785.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$22,344.01" $0.00 $0.00 $0.00 $0.00 "$24,785.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$23,605.52" $0.00 $0.00 $0.00 $0.00 $0.00 MS488 DRG MS488 KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC INPATIENT ONLY "$194,584.23" "$143,992.33" $0.00 "$263,384.75" "$137,696.34" "$137,696.34" "$24,688.76" "$24,688.76" $0.00 "$31,065.50" $0.00 $0.00 $0.00 $0.00 "$37,012.28" "$25,182.54" $0.00 $0.00 "$27,259.61" "$135,883.23" "$165,568.51" "$263,384.75" "$19,739.85" $0.00 "$19,739.85" "$13,685.26" "$29,226.72" "$29,226.72" "$25,961.53" "$14,369.52" $0.00 $0.00 $0.00 $0.00 MS489 DRG MS489 KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC INPATIENT ONLY "$85,707.36" "$63,423.45" $0.00 "$242,647.77" "$199,162.73" "$199,162.73" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$22,406.27" "$101,383.95" "$123,532.45" "$242,647.77" "$12,620.61" $0.00 "$12,620.61" $0.00 "$23,426.88" "$23,426.88" "$21,339.30" $0.00 $0.00 $0.00 $0.00 $0.00 MS492 DRG MS492 "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC" INPATIENT ONLY "$180,446.20" "$133,530.19" $0.00 "$167,518.79" "$137,567.97" "$137,567.97" "$35,001.66" "$35,001.66" $0.00 "$28,627.59" $0.00 $0.00 "$132,023.09" "$34,939.69" "$30,058.98" "$27,647.07" $0.00 $0.00 "$37,346.90" "$137,483.85" "$167,518.79" "$97,394.98" "$42,010.85" $0.00 "$42,010.85" $0.00 "$41,281.24" "$41,281.24" "$35,568.48" $0.00 $0.00 $0.00 $0.00 $0.00 MS493 DRG MS493 "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC" INPATIENT ONLY "$173,538.94" "$128,418.82" $0.00 "$136,591.07" "$118,634.14" "$118,634.14" "$27,104.97" "$27,104.97" "$30,494.41" "$20,250.93" $0.00 $0.00 "$22,271.98" "$27,063.44" "$20,250.93" "$27,647.07" "$136,591.07" "$136,591.07" "$28,127.50" "$89,392.64" "$108,921.50" "$67,758.80" "$23,075.96" "$136,591.07" "$23,075.96" "$12,466.42" "$31,944.52" "$31,944.52" "$28,127.50" "$13,089.73" $0.00 $0.00 $0.00 $0.00 MS494 DRG MS494 "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC" INPATIENT ONLY "$138,260.52" "$102,312.78" $0.00 "$95,441.38" "$26,344.79" "$26,344.79" "$23,832.96" "$23,832.96" "$13,742.95" "$16,007.13" $0.00 $0.00 "$10,821.20" "$23,799.89" "$16,007.13" "$24,309.62" "$81,035.66" "$81,035.66" "$26,181.24" "$8,346.59" "$77,751.89" "$95,441.38" "$18,158.03" "$81,035.66" "$18,158.03" "$12,466.42" "$27,938.05" "$27,938.05" "$24,934.51" "$13,089.73" $0.00 $0.00 $0.00 $0.00 MS495 DRG MS495 LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC INPATIENT ONLY "$91,782.64" "$67,919.15" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS496 DRG MS496 LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC INPATIENT ONLY "$169,241.03" "$125,238.36" $0.00 "$29,808.99" "$19,806.91" "$19,806.91" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$13,025.13" "$29,808.99" "$29,808.99" $0.00 "$13,676.38" $0.00 $0.00 $0.00 $0.00 MS497 DRG MS497 LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC INPATIENT ONLY "$75,872.17" "$56,145.41" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS498 DRG MS498 LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC INPATIENT ONLY "$117,318.76" "$86,815.88" $0.00 "$146,260.94" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$28,838.72" $0.00 $0.00 $0.00 $0.00 "$30,532.28" "$120,037.39" "$146,260.94" $0.00 "$24,540.49" $0.00 "$24,540.49" $0.00 "$33,137.63" "$33,137.63" "$29,078.36" $0.00 $0.00 $0.00 $0.00 $0.00 MS499 DRG MS499 LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC INPATIENT ONLY "$81,325.84" "$60,181.12" $0.00 "$11,045.89" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$11,045.89" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS500 DRG MS500 SOFT TISSUE PROCEDURES WITH MCC INPATIENT ONLY "$578,168.03" "$427,844.34" $0.00 "$311,174.26" "$102,731.36" "$102,731.36" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$311,174.26" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$80,884.60" "$80,884.60" $0.00 "$80,884.60" $0.00 "$80,884.60" $0.00 "$37,768.84" "$37,768.84" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS501 DRG MS501 SOFT TISSUE PROCEDURES WITH CC INPATIENT ONLY "$72,783.50" "$53,859.79" $0.00 "$116,069.81" "$4,437.05" "$4,437.05" "$23,011.70" "$23,011.70" $0.00 $0.00 $0.00 $0.00 $0.00 "$22,980.75" $0.00 "$23,471.93" $0.00 $0.00 "$25,269.62" "$95,259.31" "$116,069.81" "$62,879.13" "$16,820.79" $0.00 "$16,820.79" $0.00 "$26,848.64" "$26,848.64" "$24,066.30" $0.00 $0.00 $0.00 $0.00 $0.00 MS502 DRG MS502 SOFT TISSUE PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$101,560.84" "$75,155.02" $0.00 "$164,767.02" "$98,313.18" "$98,313.18" "$20,251.78" "$20,251.78" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$20,656.82" $0.00 $0.00 "$22,827.91" "$135,225.45" "$164,767.02" $0.00 "$14,731.48" $0.00 "$14,731.48" $0.00 "$23,930.76" "$23,930.76" "$21,740.87" $0.00 $0.00 $0.00 $0.00 $0.00 MS503 DRG MS503 FOOT PROCEDURES WITH MCC INPATIENT ONLY "$73,724.81" "$54,556.36" $0.00 "$187,255.41" $0.00 $0.00 "$29,277.56" "$29,277.56" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$29,863.11" $0.00 $0.00 "$32,367.16" "$187,255.41" "$148,306.29" $0.00 "$187,255.41" $0.00 "$187,255.41" $0.00 "$35,330.35" "$35,330.35" "$30,825.87" $0.00 $0.00 $0.00 $0.00 $0.00 MS504 DRG MS504 FOOT PROCEDURES WITH CC INPATIENT ONLY "$113,617.68" "$84,077.08" $0.00 "$148,692.35" "$142,601.36" "$142,601.36" "$23,303.62" "$23,303.62" "$33,045.90" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$23,769.69" "$148,692.35" "$148,692.35" $0.00 "$94,993.22" "$115,745.60" $0.00 "$17,407.21" "$148,692.35" "$17,407.21" $0.00 "$27,326.39" "$27,326.39" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS505 DRG MS505 FOOT PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$141,271.98" "$104,541.27" $0.00 "$133,223.81" "$14,075.15" "$14,075.15" "$23,303.62" "$23,303.62" $0.00 $0.00 $0.00 $0.00 $0.00 "$23,271.93" $0.00 "$23,769.69" $0.00 $0.00 $0.00 "$109,337.71" "$133,223.81" $0.00 "$16,855.87" $0.00 "$16,855.87" $0.00 "$26,878.91" "$26,878.91" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS506 DRG MS506 MAJOR THUMB OR JOINT PROCEDURES INPATIENT ONLY "$77,651.23" "$57,461.91" $0.00 "$21,718.38" $0.00 $0.00 "$21,292.53" "$21,292.53" $0.00 $0.00 $0.00 $0.00 $0.00 "$21,266.04" $0.00 "$21,718.38" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS507 DRG MS507 MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC INPATIENT ONLY "$147,482.67" "$109,137.18" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS508 DRG MS508 MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$152,347.28" "$112,736.99" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS510 DRG MS510 "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC" INPATIENT ONLY "$272,856.35" "$201,913.70" $0.00 "$179,649.18" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$142,790.15" $0.00 $0.00 "$30,588.88" $0.00 $0.00 $0.00 "$147,439.34" "$179,649.18" $0.00 "$27,947.77" $0.00 "$27,947.77" $0.00 "$35,913.41" "$35,913.41" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS511 DRG MS511 "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC" INPATIENT ONLY "$155,199.53" "$114,847.65" $0.00 "$119,097.38" "$119,097.38" "$119,097.38" "$24,631.47" "$24,631.47" $0.00 $0.00 $0.00 $0.00 $0.00 "$24,596.33" $0.00 "$25,124.10" $0.00 $0.00 "$26,678.75" "$83,340.79" "$101,547.55" $0.00 "$18,887.80" $0.00 "$18,887.80" "$14,202.32" "$28,532.58" "$28,532.58" "$25,408.33" "$14,912.43" $0.00 $0.00 $0.00 $0.00 MS512 DRG MS512 "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC" INPATIENT ONLY "$130,533.10" "$96,594.49" $0.00 "$69,039.85" "$4,526.08" "$4,526.08" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$43,076.17" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$8,928.39" "$69,039.85" "$47,895.51" "$15,174.79" $0.00 "$15,174.79" "$9,356.83" "$25,507.72" "$25,507.72" $0.00 "$9,824.67" $0.00 $0.00 $0.00 $0.00 MS513 DRG MS513 "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC" INPATIENT ONLY "$82,233.47" "$60,852.77" $0.00 "$95,133.80" $0.00 $0.00 "$21,902.63" "$21,902.63" $0.00 $0.00 $0.00 $0.00 "$9,665.56" "$21,874.54" $0.00 $0.00 $0.00 $0.00 $0.00 "$8,775.22" "$34,223.36" "$95,133.80" "$15,809.32" $0.00 "$15,809.32" $0.00 "$26,024.64" "$26,024.64" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS514 DRG MS514 "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC" INPATIENT ONLY "$65,501.95" "$48,471.44" $0.00 "$38,957.44" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$21,109.64" "$5,825.91" "$38,957.44" $0.00 "$10,693.93" $0.00 "$10,693.93" $0.00 "$21,857.31" "$21,857.31" "$20,104.47" $0.00 $0.00 $0.00 $0.00 $0.00 MS515 DRG MS515 OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC INPATIENT ONLY "$247,874.96" "$183,427.47" $0.00 "$265,646.77" "$265,646.77" "$265,646.77" "$32,728.31" "$32,728.31" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$33,382.88" $0.00 $0.00 "$35,356.23" "$171,828.87" "$209,366.89" $0.00 "$31,616.65" $0.00 "$31,616.65" $0.00 "$38,902.35" "$38,902.35" "$33,672.60" $0.00 $0.00 $0.00 $0.00 $0.00 MS516 DRG MS516 OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC INPATIENT ONLY "$202,001.98" "$149,481.47" $0.00 "$192,718.78" "$6,477.57" "$6,477.57" "$24,599.75" "$24,599.75" "$18,238.84" "$59,746.59" $0.00 $0.00 "$40,231.44" $0.00 "$59,758.95" "$25,091.75" "$82,828.31" "$82,828.31" "$27,053.91" "$6,215.66" "$41,578.09" "$192,718.78" "$19,438.14" "$82,828.31" "$19,438.14" $0.00 "$28,980.91" "$28,980.91" "$25,765.63" $0.00 $0.00 $0.00 $0.00 $0.00 MS517 DRG MS517 OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$105,666.11" "$78,192.92" $0.00 "$260,109.45" "$260,109.45" "$260,109.45" "$20,703.15" "$20,703.15" $0.00 $0.00 $0.00 $0.00 "$44,163.99" "$20,678.18" $0.00 "$21,117.21" $0.00 $0.00 $0.00 "$100,967.39" "$123,024.86" "$194,960.94" "$14,187.39" $0.00 "$14,187.39" $0.00 "$24,703.31" "$24,703.31" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS518 DRG MS518 BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR INPATIENT ONLY "$305,899.54" "$226,365.66" $0.00 "$53,149.12" $0.00 $0.00 "$35,808.45" "$35,808.45" $0.00 "$34,583.75" $0.00 $0.00 $0.00 "$35,744.40" "$53,149.12" "$36,524.62" $0.00 $0.00 "$35,329.63" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$35,329.63" $0.00 $0.00 $0.00 $0.00 $0.00 MS519 DRG MS519 BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC INPATIENT ONLY "$247,143.59" "$182,886.26" $0.00 "$259,633.24" "$259,633.24" "$259,633.24" "$24,580.40" "$24,580.40" $0.00 $0.00 $0.00 $0.00 "$153,503.88" $0.00 $0.00 "$25,072.01" $0.00 $0.00 $0.00 "$120,293.25" "$146,572.73" "$101,333.30" "$19,133.38" $0.00 "$19,133.38" $0.00 "$28,732.65" "$28,732.65" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS520 DRG MS520 BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC INPATIENT ONLY "$263,064.66" "$194,667.85" $0.00 "$195,326.87" $0.00 $0.00 "$20,841.86" "$20,841.86" $0.00 $0.00 $0.00 $0.00 "$195,326.87" "$20,816.53" $0.00 "$21,258.70" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS522 DRG MS522 HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC INPATIENT ONLY "$164,480.28" "$121,715.41" $0.00 "$110,446.07" "$110,446.07" "$110,446.07" "$26,163.61" "$26,163.61" $0.00 $0.00 $0.00 $0.00 $0.00 "$26,124.50" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS533 DRG MS533 FRACTURES OF FEMUR WITH MCC INPATIENT ONLY "$19,588.32" "$14,495.36" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS534 DRG MS534 FRACTURES OF FEMUR WITHOUT MCC INPATIENT ONLY "$31,460.66" "$23,280.89" $0.00 "$19,117.88" $0.00 $0.00 "$16,507.02" "$16,507.02" $0.00 $0.00 $0.00 $0.00 $0.00 "$16,492.92" $0.00 $0.00 $0.00 $0.00 "$19,117.88" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$18,207.50" $0.00 $0.00 $0.00 $0.00 $0.00 MS535 DRG MS535 FRACTURES OF HIP AND PELVIS WITH MCC INPATIENT ONLY "$54,105.68" "$40,038.20" $0.00 "$55,410.08" $0.00 $0.00 "$19,561.65" "$19,561.65" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$19,952.88" $0.00 $0.00 "$22,188.27" "$45,475.45" "$55,410.08" $0.00 "$12,300.82" $0.00 "$12,300.82" $0.00 "$23,166.38" "$23,166.38" "$21,131.69" $0.00 $0.00 $0.00 $0.00 $0.00 MS536 DRG MS536 FRACTURES OF HIP AND PELVIS WITHOUT MCC INPATIENT ONLY "$55,004.91" "$40,703.63" $0.00 "$51,105.97" "$10,159.55" "$10,159.55" "$16,379.34" "$16,379.34" $0.00 $0.00 $0.00 $0.00 $0.00 "$16,365.57" $0.00 "$16,706.93" $0.00 $0.00 "$18,985.98" "$41,943.03" "$51,105.97" $0.00 "$7,603.43" $0.00 "$7,603.43" $0.00 "$19,339.59" "$19,339.59" "$18,081.89" $0.00 $0.00 $0.00 $0.00 $0.00 MS539 DRG MS539 OSTEOMYELITIS WITH MCC INPATIENT ONLY $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS540 DRG MS540 OSTEOMYELITIS WITH CC INPATIENT ONLY "$56,790.13" "$42,024.70" $0.00 "$23,761.72" $0.00 $0.00 "$20,036.46" "$20,036.46" $0.00 "$12,280.17" $0.00 $0.00 $0.00 "$20,013.22" "$12,280.17" "$20,437.19" $0.00 $0.00 "$22,686.47" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$23,761.72" "$23,761.72" "$21,606.16" $0.00 $0.00 $0.00 $0.00 $0.00 MS541 DRG MS541 OSTEOMYELITIS WITHOUT CC/MCC INPATIENT ONLY "$16,708.96" "$12,364.63" $0.00 "$20,549.86" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$10,045.23" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$6,521.61" "$13,050.54" $0.00 "$9,089.03" $0.00 "$9,089.03" $0.00 "$20,549.86" "$20,549.86" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS542 DRG MS542 PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC INPATIENT ONLY "$48,347.24" "$35,776.96" $0.00 "$28,047.49" "$20,433.00" "$20,433.00" "$23,539.66" "$23,539.66" "$17,380.18" $0.00 $0.00 $0.00 $0.00 "$23,507.35" $0.00 "$24,010.45" "$27,138.00" "$27,138.00" $0.00 $0.00 $0.00 $0.00 $0.00 "$27,138.00" $0.00 $0.00 "$28,047.49" "$28,047.49" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS543 DRG MS543 PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC INPATIENT ONLY "$138,113.94" "$102,204.32" $0.00 "$57,212.40" "$57,212.40" "$57,212.40" "$18,266.92" "$18,266.92" $0.00 $0.00 $0.00 $0.00 $0.00 "$18,248.25" $0.00 "$19,775.46" $0.00 $0.00 "$21,021.07" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$20,020.07" $0.00 $0.00 $0.00 $0.00 $0.00 MS544 DRG MS544 PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC INPATIENT ONLY "$34,792.01" "$25,746.09" $0.00 "$20,893.70" "$20,893.70" "$20,893.70" $0.00 $0.00 "$7,083.46" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$11,665.50" "$11,665.50" $0.00 $0.00 $0.00 $0.00 $0.00 "$11,665.50" $0.00 $0.00 "$19,338.77" "$19,338.77" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS545 DRG MS545 CONNECTIVE TISSUE DISORDERS WITH MCC INPATIENT ONLY "$64,829.08" "$47,973.52" $0.00 "$55,923.33" "$26,284.20" "$26,284.20" $0.00 $0.00 "$22,618.69" "$41,824.02" $0.00 $0.00 $0.00 $0.00 "$55,923.33" $0.00 "$37,546.50" "$37,546.50" $0.00 $0.00 $0.00 $0.00 $0.00 "$37,546.50" $0.00 "$20,564.56" "$33,790.14" "$33,790.14" $0.00 "$21,592.78" $0.00 $0.00 $0.00 $0.00 MS546 DRG MS546 CONNECTIVE TISSUE DISORDERS WITH CC INPATIENT ONLY "$55,499.36" "$41,069.53" $0.00 "$39,074.00" "$20,716.21" "$20,716.21" "$19,390.49" "$19,390.49" $0.00 "$11,246.10" $0.00 $0.00 $0.00 "$19,368.91" "$11,246.10" "$19,778.30" $0.00 $0.00 $0.00 "$17,744.13" "$39,074.00" "$23,690.09" "$12,063.24" $0.00 "$12,063.24" "$10,764.02" "$22,972.84" "$22,972.84" $0.00 "$11,302.22" $0.00 $0.00 $0.00 $0.00 MS547 DRG MS547 CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC INPATIENT ONLY "$25,917.84" "$19,179.20" $0.00 "$21,983.21" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$19,338.61" "$3,981.64" "$21,983.21" $0.00 "$8,120.69" $0.00 "$8,120.69" $0.00 "$19,760.97" "$19,760.97" "$18,417.72" $0.00 $0.00 $0.00 $0.00 $0.00 MS548 DRG MS548 SEPTIC ARTHRITIS WITH MCC INPATIENT ONLY "$413,977.48" "$306,343.34" $0.00 "$33,605.39" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$33,605.39" "$33,605.39" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS549 DRG MS549 SEPTIC ARTHRITIS WITH CC INPATIENT ONLY "$59,228.85" "$43,829.35" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS550 DRG MS550 SEPTIC ARTHRITIS WITHOUT CC/MCC INPATIENT ONLY "$68,433.98" "$50,641.15" $0.00 "$20,201.14" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$3,746.96" "$9,998.30" $0.00 "$8,661.00" $0.00 "$8,661.00" $0.00 "$20,201.14" "$20,201.14" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS551 DRG MS551 MEDICAL BACK PROBLEMS WITH MCC INPATIENT ONLY "$114,513.50" "$84,739.99" $0.00 "$26,358.23" "$26,358.23" "$26,358.23" "$22,284.97" "$22,284.97" $0.00 $0.00 $0.00 $0.00 "$11,045.89" "$22,255.91" $0.00 "$22,730.67" $0.00 $0.00 "$24,664.14" $0.00 $0.00 "$25,317.60" $0.00 $0.00 $0.00 "$10,043.22" "$26,125.09" "$26,125.09" "$23,489.66" "$10,545.38" $0.00 $0.00 $0.00 $0.00 MS552 DRG MS552 MEDICAL BACK PROBLEMS WITHOUT MCC INPATIENT ONLY "$72,301.05" "$53,502.78" $0.00 "$46,583.09" "$42,175.25" "$42,175.25" "$17,564.33" "$17,564.33" "$7,763.60" "$8,531.79" $0.00 $0.00 "$23,389.21" "$17,547.49" "$8,531.79" "$17,915.62" "$14,151.00" "$14,151.00" "$20,034.27" "$3,841.70" "$46,583.09" "$46,274.32" "$9,141.16" "$14,151.00" "$9,141.16" "$8,166.06" "$41,185.53" "$41,185.53" "$19,080.26" "$8,574.36" $0.00 $0.00 $0.00 $0.00 MS553 DRG MS553 BONE DISEASES AND ARTHROPATHIES WITH MCC INPATIENT ONLY "$51,045.58" "$37,773.73" $0.00 "$28,077.22" $0.00 $0.00 "$19,860.48" "$19,860.48" $0.00 $0.00 $0.00 $0.00 $0.00 "$19,806.02" $0.00 "$20,225.30" $0.00 $0.00 "$22,587.38" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$28,077.22" "$28,077.22" "$21,511.79" $0.00 $0.00 $0.00 $0.00 $0.00 MS554 DRG MS554 BONE DISEASES AND ARTHROPATHIES WITHOUT MCC INPATIENT ONLY "$34,943.63" "$25,858.29" $0.00 "$19,573.95" "$8,173.20" "$8,173.20" "$16,522.90" "$16,522.90" "$6,492.58" $0.00 $0.00 $0.00 $0.00 "$16,508.75" $0.00 "$16,853.36" "$11,887.50" "$11,887.50" "$19,182.11" $0.00 $0.00 $0.00 $0.00 "$11,887.50" $0.00 "$7,215.26" "$19,573.95" "$19,573.95" "$18,268.68" "$7,576.01" $0.00 $0.00 $0.00 $0.00 MS555 DRG MS555 SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC INPATIENT ONLY "$55,014.70" "$40,710.88" $0.00 "$25,282.80" $0.00 $0.00 "$20,498.16" "$20,498.16" $0.00 "$10,813.74" $0.00 $0.00 $0.00 "$20,473.72" "$10,813.74" "$20,908.12" $0.00 $0.00 "$22,791.03" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$25,282.80" $0.00 $0.00 $0.00 $0.00 $0.00 MS556 DRG MS556 SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC INPATIENT ONLY "$15,857.45" "$11,734.51" $0.00 "$19,611.52" $0.00 $0.00 "$16,634.69" "$16,634.69" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$16,967.38" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$19,611.52" "$19,611.52" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS557 DRG MS557 "TENDONITIS, MYOSITIS AND BURSITIS WITH MCC" INPATIENT ONLY "$24,976.66" "$18,482.73" $0.00 "$25,053.66" $0.00 $0.00 "$20,709.35" "$20,709.35" $0.00 $0.00 $0.00 $0.00 $0.00 "$20,684.37" $0.00 "$17,338.39" $0.00 $0.00 $0.00 "$7,288.53" "$23,483.23" $0.00 "$14,617.44" $0.00 "$14,617.44" "$8,981.94" "$25,053.66" "$25,053.66" $0.00 "$9,431.03" $0.00 $0.00 $0.00 $0.00 MS558 DRG MS558 "TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC" INPATIENT ONLY "$29,084.09" "$21,522.23" $0.00 "$20,179.91" $0.00 $0.00 "$16,998.42" "$16,998.42" $0.00 "$7,373.78" $0.00 $0.00 "$3,348.41" "$16,983.03" "$7,373.78" "$17,338.39" $0.00 $0.00 "$19,689.18" "$6,684.92" "$14,709.82" $0.00 "$8,634.93" $0.00 "$8,634.93" "$7,057.69" "$20,179.91" "$20,179.91" "$18,751.60" "$7,410.57" $0.00 $0.00 $0.00 $0.00 MS559 DRG MS559 "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC" INPATIENT ONLY "$71,553.76" "$52,949.78" $0.00 "$26,115.65" $0.00 $0.00 "$23,926.84" "$23,926.84" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$24,405.38" $0.00 $0.00 "$26,115.65" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$24,872.05" $0.00 $0.00 $0.00 $0.00 $0.00 MS560 DRG MS560 "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC" INPATIENT ONLY "$37,994.06" "$28,115.60" $0.00 "$19,176.18" $0.00 $0.00 "$18,479.48" "$18,479.48" $0.00 "$4,841.55" $0.00 $0.00 $0.00 "$18,460.26" "$19,176.18" "$18,849.07" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS561 DRG MS561 "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC" INPATIENT ONLY "$13,202.24" "$9,769.66" $0.00 "$16,852.65" $0.00 $0.00 "$16,522.21" "$16,522.21" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$16,852.65" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS562 DRG MS562 "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC" INPATIENT ONLY "$19,338.11" "$14,310.20" $0.00 "$29,572.12" "$21,147.88" "$21,147.88" "$20,797.00" "$20,797.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$21,212.94" $0.00 $0.00 "$23,008.32" "$24,270.04" "$29,572.12" $0.00 "$13,503.74" $0.00 "$13,503.74" $0.00 "$24,146.36" "$24,146.36" "$21,912.69" $0.00 $0.00 $0.00 $0.00 $0.00 MS563 DRG MS563 "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC" INPATIENT ONLY "$45,179.03" "$33,432.48" $0.00 "$30,007.85" "$8,550.54" "$8,550.54" "$17,072.96" "$17,072.96" "$6,922.80" "$10,446.77" $0.00 $0.00 "$11,045.89" $0.00 "$8,103.21" "$17,414.42" "$13,083.00" "$13,083.00" "$19,638.62" "$24,627.66" "$30,007.85" "$29,566.02" "$8,560.76" "$13,083.00" "$8,560.76" "$7,755.86" "$20,119.49" "$20,119.49" "$18,703.45" "$8,143.64" $0.00 $0.00 $0.00 $0.00 MS564 DRG MS564 OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC INPATIENT ONLY "$28,508.20" "$21,096.07" $0.00 "$33,697.98" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$33,697.98" $0.00 $0.00 "$24,135.23" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$10,269.60" "$25,493.02" "$25,493.02" "$22,985.93" "$10,783.08" $0.00 $0.00 $0.00 $0.00 MS565 DRG MS565 OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC INPATIENT ONLY "$58,776.46" "$43,494.58" $0.00 "$58,773.78" $0.00 $0.00 "$18,019.16" "$18,019.16" $0.00 $0.00 $0.00 $0.00 $0.00 "$18,001.13" $0.00 "$18,379.54" $0.00 $0.00 $0.00 "$42,888.55" "$52,258.04" "$58,773.78" "$9,828.83" $0.00 "$9,828.83" "$10,269.60" "$21,152.55" "$21,152.55" $0.00 "$10,783.08" $0.00 $0.00 $0.00 $0.00 MS566 DRG MS566 OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC INPATIENT ONLY "$52,050.86" "$38,517.64" $0.00 "$19,333.07" "$14,242.21" "$14,242.21" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$19,333.07" "$19,333.07" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS570 DRG MS570 SKIN DEBRIDEMENT WITH MCC INPATIENT ONLY "$176,422.47" "$130,552.63" $0.00 "$37,352.79" $0.00 $0.00 "$30,665.46" "$30,665.46" $0.00 $0.00 $0.00 $0.00 $0.00 "$30,614.70" $0.00 "$31,278.77" $0.00 $0.00 "$29,679.42" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$37,352.79" "$37,352.79" "$29,679.42" $0.00 $0.00 $0.00 $0.00 $0.00 MS571 DRG MS571 SKIN DEBRIDEMENT WITH CC INPATIENT ONLY "$85,212.35" "$63,057.14" $0.00 "$92,480.47" $0.00 $0.00 "$59,862.87" "$59,862.87" $0.00 "$14,515.09" $0.00 $0.00 "$11,045.89" "$59,924.61" "$14,515.09" "$61,129.05" $0.00 $0.00 "$25,230.67" "$7,827.96" "$92,480.47" $0.00 "$16,763.65" $0.00 "$16,763.65" $0.00 "$26,802.10" "$26,802.10" "$24,029.21" $0.00 $0.00 $0.00 $0.00 $0.00 MS572 DRG MS572 SKIN DEBRIDEMENT WITHOUT CC/MCC INPATIENT ONLY "$94,703.95" "$70,080.92" $0.00 "$187,600.31" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$11,045.89" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$187,600.31" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS574 DRG MS574 SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC INPATIENT ONLY "$148,433.14" "$109,840.52" $0.00 "$96,481.54" "$94,618.60" "$94,618.60" $0.00 $0.00 "$23,472.88" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$96,481.54" "$96,481.54" "$96,481.54" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS575 DRG MS575 SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC INPATIENT ONLY "$159,802.59" "$118,253.92" $0.00 "$106,610.25" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$106,610.25" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS576 DRG MS576 SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC INPATIENT ONLY "$201,124.76" "$148,832.32" $0.00 "$191,834.21" $0.00 $0.00 "$187,666.77" "$187,666.77" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$191,834.21" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$52,745.32" "$52,745.32" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS577 DRG MS577 SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC INPATIENT ONLY "$326,238.97" "$241,416.84" $0.00 "$210,439.66" $0.00 $0.00 $0.00 $0.00 $0.00 "$21,509.22" $0.00 $0.00 "$152,022.01" $0.00 "$21,509.22" $0.00 $0.00 $0.00 "$30,310.19" "$172,709.30" "$210,439.66" $0.00 "$30,411.56" $0.00 "$30,411.56" "$20,587.20" "$32,872.23" "$32,872.23" "$28,866.85" "$21,616.55" $0.00 $0.00 $0.00 $0.00 MS578 DRG MS578 SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC INPATIENT ONLY "$195,675.49" "$144,799.86" $0.00 "$89,151.39" $0.00 $0.00 $0.00 $0.00 $0.00 "$15,734.20" $0.00 $0.00 $0.00 $0.00 "$15,734.20" $0.00 $0.00 $0.00 $0.00 "$6,314.74" "$89,151.39" $0.00 "$16,313.56" $0.00 "$16,313.56" $0.00 "$26,435.44" "$26,435.44" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS579 DRG MS579 "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC" INPATIENT ONLY "$204,580.32" "$151,389.44" $0.00 "$37,531.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$21,506.89" $0.00 $0.00 "$34,208.84" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$37,531.20" "$37,531.20" "$32,579.85" $0.00 $0.00 $0.00 $0.00 $0.00 MS580 DRG MS580 "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC" INPATIENT ONLY "$135,202.42" "$100,049.79" $0.00 "$103,996.14" "$103,996.14" "$103,996.14" "$22,984.77" "$22,984.77" $0.00 "$17,934.78" $0.00 $0.00 $0.00 "$22,953.89" "$17,934.78" "$23,444.47" $0.00 $0.00 "$24,796.03" "$13,426.57" "$96,657.78" $0.00 "$16,126.10" $0.00 "$16,126.10" "$13,096.07" "$26,282.71" "$26,282.71" "$23,615.27" "$13,137.34" $0.00 $0.00 $0.00 $0.00 MS581 DRG MS581 "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC" INPATIENT ONLY "$103,131.58" "$76,317.37" $0.00 "$289,721.02" "$98,764.64" "$98,764.64" $0.00 $0.00 $0.00 "$34,620.26" $0.00 $0.00 $0.00 $0.00 "$44,809.25" "$17,283.48" $0.00 $0.00 "$22,377.58" "$237,776.11" "$289,721.02" $0.00 "$51,492.35" $0.00 "$51,492.35" "$8,905.88" "$23,392.60" "$23,392.60" "$21,311.98" "$9,351.17" $0.00 $0.00 $0.00 $0.00 MS582 DRG MS582 MASTECTOMY FOR MALIGNANCY WITH CC/MCC INPATIENT ONLY "$129,566.31" "$95,879.07" $0.00 "$22,841.19" $0.00 $0.00 "$22,393.32" "$22,393.32" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$22,841.19" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS583 DRG MS583 MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC INPATIENT ONLY "$162,444.59" "$120,209.00" $0.00 "$29,509.94" $0.00 $0.00 $0.00 $0.00 $0.00 "$22,037.12" $0.00 $0.00 $0.00 $0.00 "$29,509.94" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS584 DRG MS584 "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC" INPATIENT ONLY "$94,531.64" "$69,953.41" $0.00 "$474,664.05" "$474,664.05" "$474,664.05" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$15,496.32" $0.00 $0.00 $0.00 "$16,271.13" $0.00 $0.00 $0.00 $0.00 MS585 DRG MS585 "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC" INPATIENT ONLY "$165,756.69" "$122,659.95" $0.00 "$66,928.30" $0.00 $0.00 $0.00 $0.00 $0.00 "$32,770.74" $0.00 $0.00 $0.00 $0.00 "$32,770.74" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$66,928.30" $0.00 $0.00 $0.00 "$15,175.67" $0.00 $0.00 $0.00 $0.00 MS592 DRG MS592 SKIN ULCERS WITH MCC INPATIENT ONLY "$22,209.32" "$16,434.90" $0.00 "$23,226.65" $0.00 $0.00 "$22,784.82" "$22,784.82" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$23,226.65" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$21,094.03" "$21,094.03" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS593 DRG MS593 SKIN ULCERS WITH CC INPATIENT ONLY "$15,697.87" "$11,616.42" $0.00 "$22,518.78" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$21,646.35" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$22,518.78" "$22,518.78" "$20,615.57" $0.00 $0.00 $0.00 $0.00 $0.00 MS594 DRG MS594 SKIN ULCERS WITHOUT CC/MCC INPATIENT ONLY "$24,390.66" "$18,049.09" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS595 DRG MS595 MAJOR SKIN DISORDERS WITH MCC INPATIENT ONLY "$29,157.59" "$21,576.62" $0.00 "$525,887.27" "$525,887.27" "$525,887.27" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS596 DRG MS596 MAJOR SKIN DISORDERS WITHOUT MCC INPATIENT ONLY "$18,558.10" "$13,732.99" $0.00 "$21,100.29" $0.00 $0.00 "$17,918.39" "$17,918.39" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$18,276.76" $0.00 $0.00 "$20,459.36" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$21,100.29" "$21,100.29" "$19,485.10" $0.00 $0.00 $0.00 $0.00 $0.00 MS597 DRG MS597 MALIGNANT BREAST DISORDERS WITH MCC INPATIENT ONLY "$151,439.02" "$112,064.87" $0.00 "$26,970.32" $0.00 $0.00 "$22,399.52" "$22,399.52" $0.00 $0.00 $0.00 $0.00 $0.00 "$22,370.18" $0.00 "$22,847.51" $0.00 $0.00 "$25,371.44" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$11,123.52" "$26,970.32" "$26,970.32" "$24,163.28" "$11,679.69" $0.00 $0.00 $0.00 $0.00 MS598 DRG MS598 MALIGNANT BREAST DISORDERS WITH CC INPATIENT ONLY "$10,043.51" "$7,432.20" $0.00 "$35,696.67" $0.00 $0.00 "$18,765.23" "$18,765.23" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $851.31 $0.00 $0.00 "$21,241.80" "$10,944.14" "$35,696.67" $0.00 "$10,912.47" $0.00 "$10,912.47" $0.00 "$22,035.33" "$22,035.33" "$20,230.29" $0.00 $0.00 $0.00 $0.00 $0.00 MS600 DRG MS600 NON-MALIGNANT BREAST DISORDERS WITH CC/MCC INPATIENT ONLY "$24,329.27" "$18,003.66" $0.00 "$18,292.24" $0.00 $0.00 "$17,933.57" "$17,933.57" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$18,292.24" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS601 DRG MS601 NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC INPATIENT ONLY "$11,235.84" "$8,314.52" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS602 DRG MS602 CELLULITIS WITH MCC INPATIENT ONLY "$39,242.55" "$29,039.49" $0.00 "$24,821.74" "$4,323.53" "$4,323.53" "$21,060.64" "$21,060.64" "$12,993.19" $0.00 $0.00 $0.00 $0.00 "$21,073.09" $0.00 "$17,283.48" "$21,750.00" "$21,750.00" "$23,573.49" $0.00 $0.00 "$18,754.05" $0.00 "$21,750.00" $0.00 $0.00 "$24,821.74" "$24,821.74" "$22,450.94" $0.00 $0.00 $0.00 $0.00 $0.00 MS603 DRG MS603 CELLULITIS WITHOUT MCC INPATIENT ONLY "$33,623.54" "$24,881.42" $0.00 "$20,033.73" "$16,457.97" "$16,457.97" "$16,944.59" "$16,944.59" "$7,539.56" $0.00 $0.00 $0.00 "$16,809.02" "$16,929.35" $0.00 "$17,283.48" "$12,804.00" "$12,804.00" "$19,566.86" "$6,546.00" "$17,835.13" $0.00 "$8,455.50" "$12,804.00" "$8,455.50" "$8,000.35" "$20,033.73" "$20,033.73" "$18,635.10" "$8,400.36" $0.00 $0.00 $0.00 $0.00 MS604 DRG MS604 "TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC" INPATIENT ONLY "$58,470.55" "$43,268.21" $0.00 "$101,032.73" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$21,678.25" $0.00 $0.00 "$23,810.62" "$82,918.27" "$101,032.73" $0.00 "$14,680.60" $0.00 "$14,680.60" $0.00 "$25,105.11" "$25,105.11" "$22,676.78" $0.00 $0.00 $0.00 $0.00 $0.00 MS605 DRG MS605 "TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC" INPATIENT ONLY "$44,177.90" "$32,691.65" $0.00 "$33,846.48" "$11,723.60" "$11,723.60" "$17,291.74" "$17,291.74" $0.00 "$6,598.94" $0.00 $0.00 "$9,236.98" "$17,275.60" "$6,598.94" "$17,637.57" $0.00 $0.00 "$19,786.89" "$27,778.04" "$33,846.48" $0.00 "$8,778.29" $0.00 "$8,778.29" "$6,316.06" "$20,354.44" "$20,354.44" "$18,844.66" "$6,631.86" $0.00 $0.00 $0.00 $0.00 MS606 DRG MS606 MINOR SKIN DISORDERS WITH MCC INPATIENT ONLY "$38,821.50" "$28,727.91" $0.00 "$25,358.28" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$25,358.28" "$25,358.28" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS607 DRG MS607 MINOR SKIN DISORDERS WITHOUT MCC INPATIENT ONLY "$24,146.53" "$17,868.43" $0.00 "$19,891.64" "$4,312.35" "$4,312.35" "$16,769.28" "$16,769.28" $0.00 "$6,557.31" $0.00 $0.00 "$6,696.82" "$16,754.48" "$6,557.31" "$17,104.67" $0.00 $0.00 "$19,447.95" "$6,767.14" "$9,573.60" $0.00 "$8,281.08" $0.00 "$8,281.08" $0.00 "$19,891.64" "$19,891.64" "$18,521.86" $0.00 $0.00 $0.00 $0.00 $0.00 MS614 DRG MS614 ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC INPATIENT ONLY "$332,589.59" "$246,116.30" $0.00 "$187,016.76" $0.00 $0.00 $0.00 $0.00 $0.00 "$39,122.95" $0.00 $0.00 "$187,016.76" $0.00 "$50,125.70" $0.00 $0.00 $0.00 "$30,431.14" "$137,820.12" "$167,928.51" $0.00 "$24,392.14" $0.00 "$24,392.14" $0.00 "$33,016.77" "$33,016.77" "$28,982.04" $0.00 $0.00 $0.00 $0.00 $0.00 MS615 DRG MS615 ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$152,983.56" "$113,207.83" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS616 DRG MS616 "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC" INPATIENT ONLY "$192,155.28" "$142,194.91" $0.00 "$45,817.70" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$41,143.04" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$45,817.70" "$45,817.70" "$39,183.85" $0.00 $0.00 $0.00 $0.00 $0.00 MS617 DRG MS617 "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC" INPATIENT ONLY "$70,219.82" "$51,962.67" $0.00 "$78,850.16" $0.00 $0.00 "$25,062.13" "$25,062.13" $0.00 $0.00 $0.00 $0.00 "$3,348.41" "$25,025.87" $0.00 "$25,563.37" $0.00 $0.00 "$27,820.65" "$30,246.42" "$78,850.16" $0.00 "$20,562.86" $0.00 "$20,562.86" $0.00 "$29,897.18" "$29,897.18" "$26,495.86" $0.00 $0.00 $0.00 $0.00 $0.00 MS622 DRG MS622 "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC" INPATIENT ONLY "$231,450.41" "$171,273.30" $0.00 "$150,442.75" $0.00 $0.00 $0.00 $0.00 "$41,216.66" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$150,442.75" "$150,442.75" "$150,442.75" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS623 DRG MS623 "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC" INPATIENT ONLY "$112,314.61" "$83,112.81" $0.00 "$25,933.22" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$25,933.22" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$24,698.30" $0.00 $0.00 $0.00 $0.00 $0.00 MS626 DRG MS626 "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC" INPATIENT ONLY "$190,024.42" "$140,618.07" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS627 DRG MS627 "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC" INPATIENT ONLY "$133,664.81" "$98,911.96" $0.00 "$29,066.74" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$29,066.74" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS628 DRG MS628 "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC" INPATIENT ONLY "$110,871.85" "$82,045.17" $0.00 "$39,014.36" $0.00 $0.00 "$36,446.84" "$36,446.84" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$37,175.78" $0.00 $0.00 "$39,014.36" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$37,156.53" $0.00 $0.00 $0.00 $0.00 $0.00 MS629 DRG MS629 "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC" INPATIENT ONLY "$112,509.13" "$83,256.76" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS630 DRG MS630 "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC" INPATIENT ONLY "$158,798.79" "$117,511.10" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS637 DRG MS637 DIABETES WITH MCC INPATIENT ONLY "$36,108.73" "$26,720.46" $0.00 "$40,133.70" "$16,572.15" "$16,572.15" "$20,554.07" "$20,554.07" "$12,446.04" "$23,792.53" $0.00 $0.00 $0.00 "$20,529.49" "$23,792.53" "$20,965.15" "$20,649.00" "$20,649.00" "$23,272.11" "$20,432.15" "$40,133.70" $0.00 "$13,890.67" "$20,649.00" "$13,890.67" "$12,230.98" "$24,461.58" "$24,461.58" "$22,163.91" "$12,842.52" $0.00 $0.00 $0.00 $0.00 MS638 DRG MS638 DIABETES WITH CC INPATIENT ONLY "$34,793.06" "$25,746.86" $0.00 "$22,063.63" "$12,998.32" "$12,998.32" "$17,122.64" "$17,122.64" $0.00 "$7,457.98" $0.00 $0.00 "$12,069.23" "$17,106.93" "$7,457.98" "$17,465.09" $0.00 $0.00 "$19,844.30" "$3,621.13" "$22,063.63" $0.00 "$8,862.48" $0.00 "$8,862.48" "$2,865.07" "$20,365.28" "$20,365.28" "$18,899.33" "$3,049.24" $0.00 $0.00 $0.00 $0.00 MS639 DRG MS639 DIABETES WITHOUT CC/MCC INPATIENT ONLY "$23,626.99" "$17,483.97" $0.00 "$31,516.95" $0.00 $0.00 "$15,260.63" "$15,260.63" $0.00 "$4,826.72" $0.00 $0.00 "$3,348.41" $0.00 "$5,194.00" "$15,565.84" $0.00 $0.00 "$17,993.04" "$7,233.31" "$31,516.95" $0.00 "$6,146.90" $0.00 "$6,146.90" "$4,971.35" "$18,153.00" "$18,153.00" "$17,136.23" "$5,219.92" $0.00 $0.00 $0.00 $0.00 MS640 DRG MS640 "MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC" INPATIENT ONLY "$49,024.53" "$36,278.15" $0.00 "$79,244.98" "$8,356.69" "$8,356.69" "$19,547.83" "$19,547.83" $0.00 "$9,176.07" $0.00 $0.00 $0.00 "$19,525.85" "$9,176.07" "$19,963.83" $0.00 $0.00 "$22,100.13" "$17,903.38" "$79,244.98" $0.00 "$12,171.50" $0.00 "$12,171.50" "$8,782.73" "$23,061.04" "$23,061.04" "$21,047.74" "$9,221.86" $0.00 $0.00 $0.00 $0.00 MS641 DRG MS641 "MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC" INPATIENT ONLY "$51,782.41" "$38,318.98" $0.00 "$120,359.68" "$12,711.30" "$12,711.30" "$16,258.58" "$16,258.58" "$6,293.53" $0.00 $0.00 $0.00 "$6,696.82" "$16,245.11" $0.00 "$16,583.75" "$11,313.00" "$11,313.00" "$17,809.69" "$98,780.05" "$120,359.68" $0.00 "$7,584.39" "$11,313.00" "$7,584.39" "$6,726.27" "$19,324.07" "$19,324.07" "$16,961.90" "$7,062.58" $0.00 $0.00 $0.00 $0.00 MS642 DRG MS642 INBORN AND OTHER DISORDERS OF METABOLISM INPATIENT ONLY "$38,588.82" "$28,555.73" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS643 DRG MS643 ENDOCRINE DISORDERS WITH MCC INPATIENT ONLY "$53,294.85" "$39,438.19" $0.00 "$82,100.01" $0.00 $0.00 "$22,563.09" "$22,563.09" $0.00 $0.00 $0.00 $0.00 "$10,045.23" "$22,533.31" $0.00 "$23,014.35" $0.00 $0.00 "$24,910.85" "$22,826.66" "$82,100.01" $0.00 "$16,294.50" $0.00 "$16,294.50" $0.00 "$26,419.91" "$26,419.91" "$23,724.62" $0.00 $0.00 $0.00 $0.00 $0.00 MS644 DRG MS644 ENDOCRINE DISORDERS WITH CC INPATIENT ONLY "$30,234.31" "$22,373.39" $0.00 "$21,541.26" $0.00 $0.00 "$18,091.62" "$18,091.62" $0.00 $0.00 $0.00 $0.00 $0.00 "$18,073.40" $0.00 "$18,453.45" $0.00 $0.00 "$20,828.37" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$21,541.26" "$21,541.26" "$19,836.54" $0.00 $0.00 $0.00 $0.00 $0.00 MS645 DRG MS645 ENDOCRINE DISORDERS WITHOUT CC/MCC INPATIENT ONLY "$20,021.98" "$14,816.27" $0.00 "$19,394.31" $0.00 $0.00 $0.00 $0.00 $0.00 "$4,885.00" $0.00 $0.00 $0.00 $0.00 "$6,576.23" $0.00 $0.00 $0.00 "$19,031.78" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$19,394.31" "$19,394.31" "$18,125.50" $0.00 $0.00 $0.00 $0.00 $0.00 MS653 DRG MS653 MAJOR BLADDER PROCEDURES WITH MCC INPATIENT ONLY "$422,791.72" "$312,865.87" $0.00 "$120,632.51" "$120,632.51" "$120,632.51" "$87,387.01" "$87,387.01" $0.00 "$45,216.19" $0.00 $0.00 $0.00 $0.00 "$45,216.19" "$89,154.85" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$58,358.97" "$58,358.97" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS654 DRG MS654 MAJOR BLADDER PROCEDURES WITH CC INPATIENT ONLY "$254,371.61" "$188,234.99" $0.00 "$398,005.53" $0.00 $0.00 "$31,087.15" "$31,087.15" $0.00 $0.00 $0.00 $0.00 $0.00 "$31,035.30" $0.00 "$31,708.89" $0.00 $0.00 "$33,020.46" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$398,005.53" "$38,871.58" "$38,871.58" "$31,448.06" "$398,005.53" $0.00 $0.00 $0.00 $0.00 MS655 DRG MS655 MAJOR BLADDER PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$248,905.14" "$184,189.80" $0.00 "$27,896.52" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$27,896.52" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$26,568.11" $0.00 $0.00 $0.00 $0.00 $0.00 MS656 DRG MS656 KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC INPATIENT ONLY "$508,652.91" "$376,403.15" $0.00 "$322,334.01" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$322,334.01" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS657 DRG MS657 KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC INPATIENT ONLY "$225,332.95" "$166,746.38" $0.00 "$25,489.18" $0.00 $0.00 "$24,986.36" "$24,986.36" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$25,489.18" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS658 DRG MS658 KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC INPATIENT ONLY "$296,090.66" "$219,107.09" $0.00 "$24,530.88" $0.00 $0.00 "$21,943.35" "$21,943.35" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$22,382.22" $0.00 $0.00 "$24,530.88" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$23,362.74" $0.00 $0.00 $0.00 $0.00 $0.00 MS659 DRG MS659 KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC INPATIENT ONLY "$74,221.21" "$54,923.70" $0.00 "$66,773.39" $0.00 $0.00 "$29,455.62" "$29,455.62" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$66,773.39" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$8,657.76" "$35,029.80" "$35,029.80" $0.00 "$9,090.65" $0.00 $0.00 $0.00 $0.00 MS660 DRG MS660 KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC INPATIENT ONLY "$15,538.14" "$11,498.22" $0.00 "$175,248.02" "$175,248.02" "$175,248.02" "$21,013.02" "$21,013.02" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$23,511.30" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$75,856.50" "$75,856.50" "$22,391.71" $0.00 $0.00 $0.00 $0.00 $0.00 MS661 DRG MS661 KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC INPATIENT ONLY "$84,694.84" "$62,674.18" $0.00 "$160,446.31" "$115,839.73" "$115,839.73" "$19,282.45" "$19,282.45" "$21,549.38" "$40,633.76" $0.00 $0.00 $0.00 $0.00 "$40,633.76" "$19,668.10" "$117,270.70" "$117,270.70" $0.00 "$131,679.42" "$160,446.31" $0.00 "$12,993.46" "$117,270.70" "$12,993.46" $0.00 "$44,096.27" "$44,096.27" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS663 DRG MS663 MINOR BLADDER PROCEDURES WITH CC INPATIENT ONLY "$199,962.84" "$147,972.50" $0.00 "$132,197.62" $0.00 $0.00 "$22,092.41" "$22,092.41" "$26,512.51" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$22,534.26" "$129,949.73" "$129,949.73" $0.00 "$108,495.52" "$132,197.62" $0.00 "$15,271.03" "$129,949.73" "$15,271.03" $0.00 "$25,586.10" "$25,586.10" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS664 DRG MS664 MINOR BLADDER PROCEDURES WITHOUT CC/MCC INPATIENT ONLY $0.00 $0.00 $0.00 "$88,508.75" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$88,508.75" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS667 DRG MS667 PROSTATECTOMY WITHOUT CC/MCC INPATIENT ONLY "$77,902.65" "$57,647.96" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS668 DRG MS668 TRANSURETHRAL PROCEDURES WITH MCC INPATIENT ONLY "$158,833.08" "$117,536.48" $0.00 "$35,915.88" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$31,029.55" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$35,915.88" "$35,915.88" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS669 DRG MS669 TRANSURETHRAL PROCEDURES WITH CC INPATIENT ONLY "$91,302.59" "$67,563.92" $0.00 "$22,280.82" $0.00 $0.00 "$21,843.94" "$21,843.94" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$22,280.82" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS670 DRG MS670 TRANSURETHRAL PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$139,074.86" "$102,915.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS671 DRG MS671 URETHRAL PROCEDURES WITH CC/MCC INPATIENT ONLY "$232,859.23" "$172,315.83" $0.00 "$156,574.35" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$26,291.95" "$128,501.69" "$156,574.35" $0.00 "$18,320.42" $0.00 "$18,320.42" $0.00 "$28,070.35" "$28,070.35" "$25,039.95" $0.00 $0.00 $0.00 $0.00 $0.00 MS672 DRG MS672 URETHRAL PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$137,707.44" "$101,903.51" $0.00 "$177,791.94" "$177,791.94" "$177,791.94" $0.00 $0.00 "$36,697.16" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$166,277.84" "$166,277.84" $0.00 "$112,067.60" "$136,550.05" $0.00 "$10,357.11" "$166,277.84" "$10,357.11" $0.00 "$21,582.93" "$21,582.93" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS673 DRG MS673 OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC INPATIENT ONLY "$110,049.20" "$81,436.41" $0.00 "$71,089.21" "$34,498.80" "$34,498.80" "$34,989.93" "$34,989.93" "$31,260.58" "$25,130.83" $0.00 $0.00 "$26,787.28" "$34,927.98" "$25,130.83" "$35,689.73" "$71,089.21" "$71,089.21" "$36,410.02" $0.00 $0.00 $0.00 $0.00 "$71,089.21" $0.00 $0.00 "$42,337.17" "$42,337.17" "$36,410.02" $0.00 $0.00 $0.00 $0.00 $0.00 MS674 DRG MS674 OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC INPATIENT ONLY "$131,367.95" "$97,212.28" $0.00 "$27,501.12" $0.00 $0.00 "$27,501.12" "$27,501.12" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS675 DRG MS675 OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$139,199.75" "$103,007.82" $0.00 "$26,473.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$26,473.00" "$26,473.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS682 DRG MS682 RENAL FAILURE WITH MCC INPATIENT ONLY "$43,843.12" "$32,443.91" $0.00 "$45,225.20" "$45,225.20" "$45,225.20" "$21,217.30" "$21,217.30" "$13,561.75" $0.00 $0.00 $0.00 $0.00 "$21,191.00" $0.00 "$21,641.65" "$22,090.50" "$22,090.50" "$23,902.86" "$21,793.11" "$26,628.42" $0.00 "$14,815.93" "$22,090.50" "$14,815.93" "$11,998.26" "$25,215.35" "$25,215.35" "$22,764.63" "$12,616.02" $0.00 $0.00 $0.00 $0.00 MS683 DRG MS683 RENAL FAILURE WITH CC INPATIENT ONLY "$43,023.52" "$31,837.40" $0.00 "$31,160.10" "$16,589.21" "$16,589.21" "$17,121.96" "$17,121.96" $0.00 $0.00 $0.00 $0.00 "$13,393.64" "$17,106.27" $0.00 "$17,464.40" $0.00 $0.00 "$19,934.50" "$10,177.45" "$31,160.10" $0.00 "$8,994.81" $0.00 "$8,994.81" $0.00 "$20,236.40" "$20,236.40" "$18,985.24" $0.00 $0.00 $0.00 $0.00 $0.00 MS684 DRG MS684 RENAL FAILURE WITHOUT CC/MCC INPATIENT ONLY "$10,087.95" "$7,465.08" $0.00 "$18,170.14" $0.00 $0.00 "$15,248.89" "$15,248.89" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$15,553.87" $0.00 $0.00 $0.00 "$3,360.22" "$8,379.35" $0.00 "$6,167.96" $0.00 "$6,167.96" $0.00 "$18,170.14" "$18,170.14" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS686 DRG MS686 KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC INPATIENT ONLY "$27,117.25" "$20,066.77" $0.00 "$24,475.76" $0.00 $0.00 "$23,995.84" "$23,995.84" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$24,475.76" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS687 DRG MS687 KIDNEY AND URINARY TRACT NEOPLASMS WITH CC INPATIENT ONLY "$34,699.96" "$25,677.97" $0.00 "$21,741.34" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$21,741.34" "$21,741.34" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS689 DRG MS689 KIDNEY AND URINARY TRACT INFECTIONS WITH MCC INPATIENT ONLY "$52,264.96" "$38,676.07" $0.00 "$22,280.33" "$12,330.23" "$12,330.23" "$18,743.11" "$18,743.11" $0.00 $0.00 $0.00 $0.00 "$3,348.41" "$18,723.22" $0.00 "$19,117.97" $0.00 $0.00 "$21,446.82" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$22,280.33" "$22,280.33" "$20,425.54" $0.00 $0.00 $0.00 $0.00 $0.00 MS690 DRG MS690 KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC INPATIENT ONLY "$34,630.42" "$25,626.51" $0.00 "$38,475.04" "$4,086.60" "$4,086.60" "$16,533.26" "$16,533.26" $0.00 $0.00 $0.00 $0.00 "$20,090.46" "$16,519.08" $0.00 "$16,863.93" $0.00 $0.00 "$19,206.72" "$6,663.05" "$38,475.04" $0.00 "$7,927.21" $0.00 "$7,927.21" $0.00 "$17,599.41" "$17,599.41" "$18,292.11" $0.00 $0.00 $0.00 $0.00 $0.00 MS693 DRG MS693 URINARY STONES WITH MCC INPATIENT ONLY "$37,763.02" "$27,944.63" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS694 DRG MS694 URINARY STONES WITHOUT MCC INPATIENT ONLY "$27,812.82" "$20,581.49" $0.00 "$22,027.43" "$4,116.30" "$4,116.30" "$16,375.91" "$16,375.91" $0.00 $0.00 $0.00 $0.00 $0.00 "$16,362.14" $0.00 "$16,703.43" $0.00 $0.00 "$18,862.29" "$8,086.81" "$22,027.43" $0.00 "$7,422.00" $0.00 "$7,422.00" $0.00 "$19,191.77" "$19,191.77" "$17,964.09" $0.00 $0.00 $0.00 $0.00 $0.00 MS695 DRG MS695 KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC INPATIENT ONLY "$30,389.68" "$22,488.36" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS696 DRG MS696 KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC INPATIENT ONLY "$8,697.46" "$6,436.12" $0.00 "$15,828.61" $0.00 $0.00 "$15,828.61" "$15,828.61" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $268.15 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS698 DRG MS698 OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC INPATIENT ONLY "$62,273.78" "$46,082.60" $0.00 "$26,856.59" $0.00 $0.00 "$22,169.02" "$22,169.02" $0.00 $0.00 $0.00 $0.00 "$16,742.05" "$26,856.59" $0.00 "$22,612.40" $0.00 $0.00 "$24,863.69" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$26,363.55" "$26,363.55" "$23,679.70" $0.00 $0.00 $0.00 $0.00 $0.00 MS699 DRG MS699 OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC INPATIENT ONLY "$34,407.79" "$25,461.76" $0.00 "$21,922.34" "$8,173.20" "$8,173.20" "$18,141.30" "$18,141.30" $0.00 $0.00 $0.00 $0.00 $0.00 "$18,122.96" $0.00 "$18,504.13" $0.00 $0.00 "$20,859.81" "$10,876.54" "$19,704.17" $0.00 "$10,352.10" $0.00 "$10,352.10" "$3,969.84" "$21,922.34" "$21,922.34" "$19,866.49" "$4,225.02" $0.00 $0.00 $0.00 $0.00 MS700 DRG MS700 OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC INPATIENT ONLY "$33,843.09" "$25,043.89" $0.00 "$35,130.91" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$18,871.19" "$7,542.32" "$35,130.91" $0.00 "$7,435.02" $0.00 "$7,435.02" $0.00 "$19,202.40" "$19,202.40" "$17,972.56" $0.00 $0.00 $0.00 $0.00 $0.00 MS707 DRG MS707 MAJOR MALE PELVIC PROCEDURES WITH CC/MCC INPATIENT ONLY "$245,462.36" "$181,642.15" $0.00 "$26,581.02" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $23.04 $0.00 $0.00 $0.00 $0.00 "$26,581.02" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$25,315.26" $0.00 $0.00 $0.00 $0.00 $0.00 MS708 DRG MS708 MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$191,309.76" "$141,569.22" $0.00 "$25,003.02" $0.00 $0.00 "$21,344.99" "$21,344.99" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$21,771.89" $0.00 $0.00 "$23,725.19" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$25,003.02" "$25,003.02" "$22,595.42" $0.00 $0.00 $0.00 $0.00 $0.00 MS709 DRG MS709 PENIS PROCEDURES WITH CC/MCC INPATIENT ONLY "$184,084.60" "$136,222.60" $0.00 "$32,790.56" $0.00 $0.00 "$27,036.64" "$27,036.64" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$27,577.37" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$32,790.56" "$32,790.56" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS710 DRG MS710 PENIS PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$64,254.48" "$47,548.32" $0.00 "$120,205.88" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$22,549.05" $0.00 $0.00 $0.00 $0.00 $0.00 "$120,205.88" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS711 DRG MS711 TESTES PROCEDURES WITH CC/MCC INPATIENT ONLY "$99,610.22" "$73,711.56" $0.00 "$85,899.31" $0.00 $0.00 $0.00 $0.00 $0.00 "$17,621.76" $0.00 $0.00 $0.00 $0.00 "$17,621.76" $0.00 $0.00 $0.00 $0.00 "$4,158.09" "$85,899.31" $0.00 "$21,484.09" $0.00 "$21,484.09" $0.00 "$30,647.69" "$30,647.69" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS713 DRG MS713 TRANSURETHRAL PROSTATECTOMY WITH CC/MCC INPATIENT ONLY "$82,750.61" "$61,235.45" $0.00 "$25,084.68" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$12,211.96" "$25,084.68" "$25,084.68" $0.00 "$12,822.56" $0.00 $0.00 $0.00 $0.00 MS714 DRG MS714 TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC INPATIENT ONLY "$112,034.77" "$82,905.73" $0.00 "$20,620.89" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$20,620.89" "$20,620.89" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS715 DRG MS715 OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC INPATIENT ONLY "$40,796.73" "$30,189.58" $0.00 "$148,588.40" $0.00 $0.00 "$25,005.54" "$25,005.54" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$121,947.55" "$148,588.40" $0.00 "$21,416.93" $0.00 "$21,416.93" $0.00 "$30,592.97" "$30,592.97" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS717 DRG MS717 OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC INPATIENT ONLY "$2,327,046.38" "$1,722,014.32" $0.00 "$326,740.55" "$178,318.50" "$178,318.50" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$23,674.83" $0.00 $0.00 "$326,740.55" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$23,674.83" $0.00 $0.00 $0.00 $0.00 $0.00 MS718 DRG MS718 OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC INPATIENT ONLY "$158,309.83" "$117,149.27" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS722 DRG MS722 "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC" INPATIENT ONLY "$13,710.93" "$10,146.09" $0.00 "$26,136.81" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$26,136.81" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$24,892.20" $0.00 $0.00 $0.00 $0.00 $0.00 MS723 DRG MS723 "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC" INPATIENT ONLY "$21,568.66" "$15,960.81" $0.00 "$22,188.86" $0.00 $0.00 "$18,589.21" "$18,589.21" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$18,960.99" $0.00 $0.00 "$21,370.28" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$22,188.86" "$22,188.86" "$20,352.65" $0.00 $0.00 $0.00 $0.00 $0.00 MS725 DRG MS725 BENIGN PROSTATIC HYPERTROPHY WITH MCC INPATIENT ONLY "$120,705.19" "$89,321.84" $0.00 "$23,861.50" $0.00 $0.00 "$19,925.34" "$19,925.34" $0.00 $0.00 $0.00 $0.00 $0.00 "$19,902.39" $0.00 $0.00 $0.00 $0.00 "$22,381.68" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$23,861.50" "$23,861.50" "$21,315.89" $0.00 $0.00 $0.00 $0.00 $0.00 MS727 DRG MS727 INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC INPATIENT ONLY "$19,627.88" "$14,524.63" $0.00 "$23,556.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$23,556.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$22,434.67" $0.00 $0.00 $0.00 $0.00 $0.00 MS728 DRG MS728 INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC INPATIENT ONLY "$17,324.91" "$12,820.43" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS729 DRG MS729 OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC INPATIENT ONLY "$53,996.15" "$39,957.15" $0.00 "$21,997.01" $0.00 $0.00 "$21,565.70" "$21,565.70" $0.00 $0.00 $0.00 $0.00 $0.00 "$21,538.45" $0.00 "$21,997.01" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS730 DRG MS730 OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC INPATIENT ONLY "$55,239.20" "$40,877.01" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS736 DRG MS736 UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC INPATIENT ONLY "$342,516.71" "$253,462.37" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS737 DRG MS737 UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC INPATIENT ONLY "$149,825.85" "$110,871.13" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS738 DRG MS738 UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC INPATIENT ONLY "$190,239.02" "$140,776.87" $0.00 "$23,225.63" $0.00 $0.00 "$21,239.38" "$21,239.38" $0.00 $0.00 $0.00 $0.00 $0.00 "$21,213.03" $0.00 $0.00 $0.00 $0.00 "$23,225.63" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$22,119.65" $0.00 $0.00 $0.00 $0.00 $0.00 MS739 DRG MS739 UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC INPATIENT ONLY "$345,645.71" "$255,777.83" $0.00 "$76,002.23" $0.00 $0.00 "$37,444.79" "$37,444.79" $0.00 $0.00 $0.00 $0.00 $0.00 "$37,376.50" $0.00 $0.00 $0.00 $0.00 "$39,391.56" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$76,002.23" "$76,002.23" "$37,515.77" $0.00 $0.00 $0.00 $0.00 $0.00 MS740 DRG MS740 UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC INPATIENT ONLY "$289,589.03" "$214,295.88" $0.00 "$27,721.64" $0.00 $0.00 "$23,487.20" "$23,487.20" $0.00 $0.00 $0.00 $0.00 $0.00 "$23,455.02" $0.00 "$23,956.94" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$27,721.64" "$27,721.64" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS741 DRG MS741 UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC INPATIENT ONLY "$220,233.64" "$162,972.89" $0.00 "$156,113.16" "$141,373.62" "$141,373.62" $0.00 $0.00 "$29,872.05" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$143,113.04" "$143,113.04" $0.00 "$128,123.16" "$156,113.16" $0.00 "$13,327.31" "$143,113.04" "$13,327.31" $0.00 "$24,002.64" "$24,002.64" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS742 DRG MS742 UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC INPATIENT ONLY "$178,499.01" "$132,089.27" $0.00 "$144,571.35" "$4,086.60" "$4,086.60" "$22,910.93" "$22,910.93" $0.00 "$14,751.72" $0.00 $0.00 $0.00 "$22,880.25" "$21,251.43" "$23,369.15" $0.00 $0.00 "$25,364.14" "$118,650.74" "$144,571.35" "$135,777.03" "$16,936.07" $0.00 "$16,936.07" $0.00 "$26,942.56" "$26,942.56" "$24,156.36" $0.00 $0.00 $0.00 $0.00 $0.00 MS743 DRG MS743 UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC INPATIENT ONLY "$215,798.10" "$159,690.59" $0.00 "$113,095.63" "$113,095.63" "$113,095.63" "$27,072.03" "$27,072.03" $0.00 "$22,501.93" $0.00 $0.00 $0.00 "$27,069.04" "$22,968.22" "$27,614.54" $0.00 $0.00 $0.00 "$16,934.63" "$94,504.91" $0.00 "$11,512.92" $0.00 "$11,512.92" "$8,031.14" "$22,524.51" "$22,524.51" $0.00 "$8,432.69" $0.00 $0.00 $0.00 $0.00 MS744 DRG MS744 "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC" INPATIENT ONLY "$235,639.36" "$174,373.13" $0.00 "$10,045.23" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$10,045.23" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS745 DRG MS745 "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC" INPATIENT ONLY "$91,531.43" "$67,733.26" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS746 DRG MS746 "VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC" INPATIENT ONLY $0.00 $0.00 $0.00 "$75,281.45" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$24,948.45" $0.00 $0.00 "$75,281.45" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$23,760.43" $0.00 $0.00 $0.00 $0.00 $0.00 MS748 DRG MS748 FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES INPATIENT ONLY "$154,956.04" "$114,667.47" $0.00 "$101,307.70" $0.00 $0.00 $0.00 $0.00 "$14,571.85" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$99,574.54" "$99,574.54" $0.00 "$83,143.95" "$101,307.70" $0.00 "$13,249.13" "$99,574.54" "$13,249.13" $0.00 "$23,938.94" "$23,938.94" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS749 DRG MS749 OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC INPATIENT ONLY "$113,765.76" "$84,186.66" $0.00 "$104,733.83" "$104,733.83" "$104,733.83" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$31,516.36" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$30,015.58" $0.00 $0.00 $0.00 $0.00 $0.00 MS754 DRG MS754 "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC" INPATIENT ONLY "$172,896.37" "$127,943.31" $0.00 "$27,533.80" $0.00 $0.00 "$23,656.98" "$23,656.98" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$11,631.52" "$27,533.80" "$27,533.80" $0.00 "$12,213.09" $0.00 $0.00 $0.00 $0.00 MS755 DRG MS755 "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC" INPATIENT ONLY "$31,589.96" "$23,376.57" $0.00 "$20,798.98" $0.00 $0.00 $0.00 $0.00 $0.00 "$6,164.57" $0.00 $0.00 $0.00 "$18,827.17" "$10,971.74" $0.00 $0.00 $0.00 "$20,798.98" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$19,808.55" $0.00 $0.00 $0.00 $0.00 $0.00 MS756 DRG MS756 "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC" INPATIENT ONLY "$13,121.56" "$9,709.95" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS757 DRG MS757 "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC" INPATIENT ONLY "$32,053.15" "$23,719.33" $0.00 "$29,643.01" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$23,508.57" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$29,643.01" "$29,643.01" "$22,389.11" $0.00 $0.00 $0.00 $0.00 $0.00 MS758 DRG MS758 "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC" INPATIENT ONLY "$32,039.33" "$23,709.10" $0.00 "$20,399.89" "$12,259.80" "$12,259.80" $0.00 $0.00 "$9,388.08" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$14,545.50" "$14,545.50" "$20,399.89" $0.00 $0.00 $0.00 $0.00 "$14,545.50" $0.00 $0.00 $0.00 $0.00 "$19,428.47" $0.00 $0.00 $0.00 $0.00 $0.00 MS759 DRG MS759 "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC" INPATIENT ONLY "$31,529.67" "$23,331.96" $0.00 "$5,834.14" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$5,556.33" $0.00 $0.00 $0.00 "$5,834.14" $0.00 $0.00 $0.00 $0.00 MS760 DRG MS760 MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC INPATIENT ONLY "$22,036.45" "$16,306.97" $0.00 "$12,958.36" "$12,958.36" "$12,958.36" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS761 DRG MS761 MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC INPATIENT ONLY "$26,444.46" "$19,568.90" $0.00 "$12,489.77" "$12,489.77" "$12,489.77" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS768 DRG MS768 VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C INPATIENT ONLY "$40,711.25" "$30,126.33" $0.00 "$21,373.04" "$19,822.68" "$19,822.68" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$5,061.36" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$14,855.59" "$20,902.18" $0.00 "$10,099.48" $0.00 "$10,099.48" "$5,802.63" "$21,373.04" "$21,373.04" $0.00 "$6,092.76" $0.00 $0.00 $0.00 $0.00 MS769 DRG MS769 POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES INPATIENT ONLY "$269,978.86" "$199,784.36" $0.00 "$175,470.46" "$172,148.03" "$172,148.03" $0.00 $0.00 "$43,372.20" "$12,300.04" $0.00 $0.00 $0.00 $0.00 "$12,300.04" $0.00 "$175,470.46" "$175,470.46" $0.00 $0.00 $0.00 $0.00 $0.00 "$175,470.46" $0.00 "$11,772.78" $0.00 $0.00 $0.00 "$12,361.42" $0.00 $0.00 $0.00 $0.00 MS770 DRG MS770 "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY" INPATIENT ONLY "$31,584.85" "$23,372.79" $0.00 "$6,160.27" $0.00 $0.00 $0.00 $0.00 $0.00 "$6,129.68" $0.00 $0.00 $0.00 $0.00 "$6,129.68" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$5,866.92" $0.00 $0.00 $0.00 "$6,160.27" $0.00 $0.00 $0.00 $0.00 MS776 DRG MS776 POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES INPATIENT ONLY "$15,568.58" "$11,520.75" $0.00 "$18,942.70" "$8,173.20" "$8,173.20" $0.00 $0.00 $0.00 "$2,725.88" $0.00 $0.00 "$3,348.41" $0.00 "$6,136.30" $0.00 $0.00 $0.00 $0.00 "$3,376.61" "$3,044.04" "$13,481.20" "$3,843.48" $0.00 "$3,843.48" "$5,873.26" "$18,942.70" "$18,942.70" $0.00 "$6,166.92" $0.00 $0.00 $0.00 $0.00 MS779 DRG MS779 ABORTION WITHOUT D&C INPATIENT ONLY "$16,003.04" "$11,842.25" $0.00 "$23,300.47" "$4,106.40" "$4,106.40" $0.00 $0.00 $0.00 "$5,080.47" $0.00 $0.00 $0.00 $0.00 "$5,080.47" $0.00 $0.00 $0.00 $0.00 "$16,835.84" "$23,300.47" $0.00 "$11,445.75" $0.00 "$11,445.75" "$1,430.21" "$22,469.79" "$22,469.79" $0.00 "$1,522.14" $0.00 $0.00 $0.00 $0.00 MS783 DRG MS783 CESAREAN SECTION WITH STERILIZATION WITH MCC INPATIENT ONLY "$71,796.43" "$53,129.36" $0.00 "$13,830.75" "$13,830.75" "$13,830.75" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$9,087.89" $0.00 $0.00 $0.00 "$9,542.28" $0.00 $0.00 $0.00 $0.00 MS784 DRG MS784 CESAREAN SECTION WITH STERILIZATION WITH CC INPATIENT ONLY "$69,676.31" "$51,560.47" $0.00 "$37,137.03" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$7,288.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$7,705.74" "$37,137.03" "$12,460.97" "$10,477.40" $0.00 "$10,477.40" "$9,087.89" "$21,680.91" "$21,680.91" $0.00 "$9,542.28" $0.00 $0.00 $0.00 $0.00 MS785 DRG MS785 CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC INPATIENT ONLY "$66,138.83" "$48,942.73" $0.00 "$52,378.97" "$14,254.51" "$14,254.51" $0.00 $0.00 "$52,378.97" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$13,752.00" "$13,752.00" $0.00 $0.00 $0.00 $0.00 $0.00 "$13,752.00" $0.00 "$9,087.89" $0.00 $0.00 $0.00 "$9,542.28" $0.00 $0.00 $0.00 $0.00 MS786 DRG MS786 CESAREAN SECTION WITHOUT STERILIZATION WITH MCC INPATIENT ONLY "$64,226.23" "$47,527.41" $0.00 "$51,796.52" "$13,929.31" "$13,929.31" "$22,095.35" "$22,095.35" "$7,050.47" $0.00 $0.00 $0.00 "$13,985.42" "$22,067.08" $0.00 $0.00 "$23,916.00" "$23,916.00" $0.00 "$24,076.48" "$51,796.52" "$27,565.16" "$17,186.67" "$23,916.00" "$17,186.67" "$9,087.89" "$27,146.72" "$27,146.72" $0.00 "$9,542.28" $0.00 $0.00 $0.00 $0.00 MS787 DRG MS787 CESAREAN SECTION WITHOUT STERILIZATION WITH CC INPATIENT ONLY "$60,021.02" "$44,415.55" $0.00 "$38,858.99" "$13,908.48" "$13,908.48" "$18,399.43" "$18,399.43" "$9,500.59" $0.00 $0.00 $0.00 "$7,288.60" $0.00 $0.00 $0.00 "$15,966.00" "$15,966.00" "$20,947.28" "$7,707.95" "$38,858.99" $0.00 "$10,480.42" "$15,966.00" "$10,480.42" "$9,087.89" "$21,683.37" "$21,683.37" "$19,949.79" "$9,542.28" $0.00 $0.00 $0.00 $0.00 MS788 DRG MS788 CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC INPATIENT ONLY "$53,940.94" "$39,916.30" $0.00 "$37,750.88" "$13,582.80" "$13,582.80" $0.00 $0.00 "$7,920.73" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$13,311.00" "$13,311.00" $0.00 "$13,361.92" "$37,750.88" $0.00 "$9,084.02" "$13,311.00" "$9,084.02" "$7,405.42" "$20,545.77" "$20,545.77" $0.00 "$7,775.68" $0.00 $0.00 $0.00 $0.00 MS789 DRG MS789 "NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY" INPATIENT ONLY "$12,236.12" "$9,054.73" $0.00 "$20,596.05" "$4,334.40" "$4,334.40" $0.00 $0.00 $0.00 "$18,997.58" $0.00 $0.00 "$14,581.12" $0.00 "$18,997.58" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$20,596.05" $0.00 $0.00 $0.00 $219.20 $0.00 $0.00 $0.00 $0.00 MS790 DRG MS790 "EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE" INPATIENT ONLY "$47,484.99" "$35,138.89" $0.00 "$345,528.12" "$227,852.34" "$227,852.34" $0.00 $0.00 $0.00 "$6,824.32" $0.00 $0.00 $0.00 $0.00 "$6,824.32" $0.00 $0.00 $0.00 $0.00 "$283,577.38" "$345,528.12" $0.00 "$76,626.93" $0.00 "$76,626.93" "$24,017.10" "$58,657.03" "$58,657.03" $0.00 "$25,214.25" $0.00 $0.00 $0.00 $0.00 MS791 DRG MS791 PREMATURITY WITH MAJOR PROBLEMS INPATIENT ONLY "$106,775.51" "$79,013.88" $0.00 "$131,833.16" "$86,741.10" "$86,741.10" $0.00 $0.00 $0.00 "$3,625.61" $0.00 $0.00 $0.00 $0.00 "$3,625.61" $0.00 $0.00 $0.00 $0.00 "$16,878.92" "$15,649.71" "$131,833.16" "$19,759.75" $0.00 "$19,759.75" "$21,244.37" "$44,228.51" "$44,228.51" $0.00 "$22,302.88" $0.00 $0.00 $0.00 $0.00 MS792 DRG MS792 PREMATURITY WITHOUT MAJOR PROBLEMS INPATIENT ONLY "$9,474.02" "$7,010.77" $0.00 "$31,899.59" "$5,534.55" "$5,534.55" $0.00 $0.00 $0.00 "$2,752.37" $0.00 $0.00 $0.00 $0.00 "$2,752.37" $0.00 $0.00 $0.00 $0.00 "$5,340.18" "$4,229.42" $0.00 "$5,340.18" $0.00 "$5,340.18" "$3,473.37" "$31,899.59" "$31,899.59" $0.00 "$3,643.33" $0.00 $0.00 $0.00 $0.00 MS793 DRG MS793 FULL TERM NEONATE WITH MAJOR PROBLEMS INPATIENT ONLY "$31,960.27" "$23,650.60" $0.00 "$73,489.93" "$32,199.00" "$32,199.00" $0.00 $0.00 "$16,677.00" $0.00 $0.00 $0.00 "$48,678.47" $0.00 $0.00 $0.00 "$73,489.93" "$73,489.93" $0.00 "$4,386.25" "$3,473.91" "$19,810.22" "$4,386.25" "$73,489.93" "$4,386.25" "$21,244.37" "$45,073.74" "$45,073.74" $0.00 "$22,302.88" $0.00 $0.00 $0.00 $0.00 MS794 DRG MS794 NEONATE WITH OTHER SIGNIFICANT PROBLEMS INPATIENT ONLY "$6,506.03" "$4,814.46" $0.00 "$24,446.07" "$3,699.60" "$3,699.60" $0.00 $0.00 "$4,761.00" $0.00 $0.00 $0.00 "$2,023.02" $0.00 $0.00 $0.00 "$21,126.00" "$21,126.00" $0.00 "$5,394.25" "$4,272.25" $0.00 "$5,394.25" "$21,126.00" "$5,394.25" "$2,637.56" "$24,446.07" "$24,446.07" $0.00 "$2,765.74" $0.00 $0.00 $0.00 $0.00 MS795 DRG MS795 NORMAL NEWBORN INPATIENT ONLY "$4,674.03" "$3,458.78" $0.00 "$14,674.90" "$3,689.70" "$3,689.70" $0.00 $0.00 "$1,012.00" "$1,296.58" $0.00 $0.00 "$2,023.02" $0.00 "$2,139.31" $0.00 "$2,860.50" "$2,860.50" $0.00 "$1,781.77" "$3,743.93" "$2,259.28" "$1,877.55" "$2,860.50" "$1,877.55" "$2,050.78" "$14,674.90" "$14,674.90" $0.00 "$2,149.62" $0.00 $0.00 $0.00 $0.00 MS796 DRG MS796 VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC INPATIENT ONLY "$54,907.25" "$40,631.37" $0.00 "$8,366.13" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$5,061.36" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$7,967.75" $0.00 $0.00 $0.00 "$8,366.13" $0.00 $0.00 $0.00 $0.00 MS797 DRG MS797 VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC INPATIENT ONLY "$45,318.16" "$33,535.44" $0.00 "$8,366.13" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$7,967.75" $0.00 $0.00 $0.00 "$8,366.13" $0.00 $0.00 $0.00 $0.00 MS798 DRG MS798 VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC INPATIENT ONLY "$52,110.07" "$38,561.45" $0.00 "$8,366.13" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$5,061.36" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$7,967.75" $0.00 $0.00 $0.00 "$8,366.13" $0.00 $0.00 $0.00 $0.00 MS799 DRG MS799 SPLENECTOMY WITH MCC INPATIENT ONLY "$327,183.49" "$242,115.78" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS801 DRG MS801 SPLENECTOMY WITHOUT CC/MCC INPATIENT ONLY "$172,895.48" "$127,942.66" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS802 DRG MS802 OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC INPATIENT ONLY "$596,528.35" "$441,430.98" $0.00 "$96,469.48" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$96,469.48" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS803 DRG MS803 OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC INPATIENT ONLY "$251,863.58" "$186,379.05" $0.00 "$27,694.69" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$27,694.69" "$27,694.69" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS805 DRG MS805 VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC INPATIENT ONLY "$30,983.57" "$22,927.84" $0.00 "$29,462.16" "$11,805.47" "$11,805.47" $0.00 $0.00 "$29,462.16" $0.00 $0.00 $0.00 "$7,076.75" $0.00 $0.00 $0.00 "$15,448.50" "$15,448.50" $0.00 "$7,672.56" "$14,281.34" $0.00 "$10,432.30" "$15,448.50" "$10,432.30" "$6,630.28" "$25,233.70" "$25,233.70" $0.00 "$6,961.79" $0.00 $0.00 $0.00 $0.00 MS806 DRG MS806 VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC INPATIENT ONLY "$25,294.22" "$18,717.72" $0.00 "$21,350.23" "$8,052.96" "$8,052.96" $0.00 $0.00 "$6,550.61" $0.00 $0.00 $0.00 "$5,061.36" $0.00 $0.00 $0.00 "$11,019.00" "$11,019.00" "$18,649.09" "$7,746.04" "$13,604.81" "$21,350.23" "$7,109.24" "$11,019.00" "$7,109.24" "$5,802.63" "$18,936.98" "$18,936.98" "$17,761.04" "$6,092.76" $0.00 $0.00 $0.00 $0.00 MS807 DRG MS807 VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC INPATIENT ONLY "$22,303.67" "$16,504.72" $0.00 "$18,264.05" "$8,254.49" "$8,254.49" $0.00 $0.00 "$5,733.00" $0.00 $0.00 $0.00 "$5,061.36" $0.00 $0.00 $0.00 "$9,634.50" "$9,634.50" $0.00 "$8,401.97" "$11,615.99" "$17,521.13" "$6,283.23" "$9,634.50" "$6,283.23" "$5,802.63" "$18,264.05" "$18,264.05" $0.00 "$6,092.76" $0.00 $0.00 $0.00 $0.00 MS808 DRG MS808 MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC INPATIENT ONLY "$34,593.18" "$25,598.95" $0.00 "$30,536.62" $0.00 $0.00 "$26,138.77" "$26,138.77" $0.00 $0.00 $0.00 $0.00 $0.00 "$26,099.74" $0.00 "$26,661.55" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$30,536.62" "$30,536.62" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS809 DRG MS809 MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC INPATIENT ONLY "$75,870.07" "$56,143.85" $0.00 "$22,111.75" $0.00 $0.00 "$19,496.75" "$19,496.75" $0.00 "$12,843.09" $0.00 $0.00 $0.00 "$19,474.91" "$12,843.09" "$19,886.69" $0.00 $0.00 "$22,111.75" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$21,058.81" $0.00 $0.00 $0.00 $0.00 $0.00 MS810 DRG MS810 MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC INPATIENT ONLY "$26,038.35" "$19,268.38" $0.00 "$20,194.88" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$20,194.88" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$19,233.22" $0.00 $0.00 $0.00 $0.00 $0.00 MS811 DRG MS811 RED BLOOD CELL DISORDERS WITH MCC INPATIENT ONLY "$37,057.02" "$27,422.19" $0.00 "$78,735.41" "$23,615.76" "$23,615.76" "$20,572.70" "$20,572.70" "$11,450.82" "$3,403.76" $0.00 $0.00 "$10,045.23" "$20,548.08" "$14,177.07" "$20,984.15" "$20,689.50" "$20,689.50" "$22,961.85" "$19,762.72" "$78,735.41" $0.00 "$13,435.57" "$20,689.50" "$13,435.57" "$30,963.95" "$24,090.82" "$24,090.82" "$21,868.43" "$30,963.95" $0.00 $0.00 $0.00 $0.00 MS812 DRG MS812 RED BLOOD CELL DISORDERS WITHOUT MCC INPATIENT ONLY "$30,116.25" "$22,286.03" $0.00 "$24,519.60" "$24,519.60" "$24,519.60" "$17,128.85" "$17,128.85" "$7,285.18" "$8,031.31" $0.00 $0.00 "$13,393.64" "$17,113.13" "$8,031.31" "$17,471.43" "$13,204.50" "$13,204.50" "$19,752.74" "$3,776.02" "$13,151.79" $0.00 "$8,728.17" "$13,204.50" "$8,728.17" "$7,687.04" "$20,255.87" "$20,255.87" "$18,812.13" "$8,071.38" $0.00 $0.00 $0.00 $0.00 MS813 DRG MS813 COAGULATION DISORDERS INPATIENT ONLY "$130,887.07" "$96,856.43" $0.00 "$87,448.69" $0.00 $0.00 "$21,716.98" "$21,716.98" $0.00 "$11,549.79" $0.00 $0.00 $0.00 "$21,689.39" "$11,549.79" "$22,151.32" $0.00 $0.00 $0.00 "$23,373.77" "$87,448.69" $0.00 "$15,890.52" $0.00 "$15,890.52" $0.00 "$52,183.21" "$52,183.21" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS814 DRG MS814 RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC INPATIENT ONLY "$30,605.13" "$22,647.80" $0.00 "$27,429.29" $0.00 $0.00 "$24,109.04" "$24,109.04" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$24,591.22" $0.00 $0.00 "$25,755.50" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$27,429.29" "$27,429.29" "$24,529.05" $0.00 $0.00 $0.00 $0.00 $0.00 MS815 DRG MS815 RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC INPATIENT ONLY "$62,708.27" "$46,404.12" $0.00 "$21,416.31" $0.00 $0.00 $0.00 $0.00 $0.00 "$11,825.34" $0.00 $0.00 "$16,742.05" $0.00 "$18,141.81" $0.00 $0.00 $0.00 "$20,723.81" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$21,416.31" "$21,416.31" "$19,736.96" $0.00 $0.00 $0.00 $0.00 $0.00 MS816 DRG MS816 RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC INPATIENT ONLY "$36,966.21" "$27,355.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS817 DRG MS817 OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC INPATIENT ONLY "$331,165.41" "$245,062.40" $0.00 "$196,880.15" "$12,259.80" "$12,259.80" $0.00 $0.00 "$196,880.15" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$196,880.15" "$196,880.15" $0.00 "$32,736.50" "$78,339.09" $0.00 "$25,223.16" "$196,880.15" "$25,223.16" "$11,253.79" "$33,693.78" "$33,693.78" $0.00 "$7,558.26" $0.00 $0.00 $0.00 $0.00 MS818 DRG MS818 OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC INPATIENT ONLY "$97,432.35" "$72,099.94" $0.00 "$86,024.42" $0.00 $0.00 $0.00 $0.00 "$86,024.42" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$20,397.00" "$20,397.00" $0.00 $0.00 $0.00 $0.00 $0.00 "$20,397.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS819 DRG MS819 OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$70,909.67" "$52,473.16" $0.00 "$7,495.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$7,138.29" $0.00 $0.00 $0.00 "$7,495.20" $0.00 $0.00 $0.00 $0.00 MS821 DRG MS821 LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC INPATIENT ONLY "$162,576.13" "$120,306.34" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS823 DRG MS823 LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC INPATIENT ONLY "$630,888.82" "$466,857.73" $0.00 "$65,586.69" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$65,586.69" "$65,586.69" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS824 DRG MS824 LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC INPATIENT ONLY "$51,601.70" "$38,185.26" $0.00 "$28,418.19" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$28,418.19" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS826 DRG MS826 MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC INPATIENT ONLY "$379,947.04" "$281,160.81" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS827 DRG MS827 MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC INPATIENT ONLY "$423,291.52" "$313,235.72" $0.00 "$32,906.05" $0.00 $0.00 "$32,906.05" "$32,906.05" $0.00 $0.00 $0.00 $0.00 $0.00 "$32,906.05" $0.00 $0.00 $0.00 $0.00 "$32,906.05" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$32,906.05" $0.00 $0.00 $0.00 $0.00 $0.00 MS828 DRG MS828 MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$247,026.79" "$182,799.82" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS829 DRG MS829 MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC INPATIENT ONLY "$279,328.65" "$206,703.20" $0.00 "$38,787.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$38,787.20" "$38,787.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS830 DRG MS830 MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$211,300.46" "$156,362.34" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS831 DRG MS831 OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC INPATIENT ONLY "$29,160.39" "$21,578.69" $0.00 "$21,952.85" "$20,552.75" "$20,552.75" $0.00 $0.00 "$10,012.94" $0.00 $0.00 $0.00 "$14,394.30" $0.00 $0.00 $0.00 "$16,827.00" "$16,827.00" $0.00 "$9,939.05" "$19,151.15" $0.00 "$10,811.22" "$16,827.00" "$10,811.22" "$7,138.29" "$21,952.85" "$21,952.85" $0.00 "$7,495.20" $0.00 $0.00 $0.00 $0.00 MS832 DRG MS832 OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC INPATIENT ONLY "$20,347.40" "$15,057.08" $0.00 "$18,988.42" "$12,259.80" "$12,259.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$6,696.82" $0.00 $0.00 $0.00 $0.00 $0.00 "$18,692.12" "$2,930.57" "$10,159.89" $0.00 "$7,172.39" $0.00 "$7,172.39" "$7,138.29" "$18,988.42" "$18,988.42" "$17,802.02" "$7,495.20" $0.00 $0.00 $0.00 $0.00 MS833 DRG MS833 OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$14,743.82" "$10,910.43" $0.00 "$10,045.23" "$8,272.70" "$8,272.70" $0.00 $0.00 "$2,152.00" $0.00 $0.00 $0.00 "$10,045.23" $0.00 $0.00 $0.00 "$4,723.00" "$4,723.00" $0.00 "$7,048.80" "$7,048.80" "$6,068.80" "$7,048.80" "$4,723.00" "$7,048.80" "$5,802.63" "$7,048.80" "$7,048.80" $0.00 "$6,092.76" $0.00 $0.00 $0.00 $0.00 MS834 DRG MS834 ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC INPATIENT ONLY "$507,748.30" "$375,733.74" $0.00 "$56,196.91" $0.00 $0.00 "$55,070.71" "$55,070.71" $0.00 $0.00 $0.00 $0.00 $0.00 "$55,066.67" $0.00 "$56,196.91" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS835 DRG MS835 ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC INPATIENT ONLY "$40,262.10" "$29,793.95" $0.00 "$10,045.23" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$10,045.23" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS836 DRG MS836 ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$18,640.57" "$13,794.02" $0.00 "$23,905.45" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$23,905.45" "$23,905.45" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS837 DRG MS837 CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC INPATIENT ONLY "$51,339.82" "$37,991.47" $0.00 "$62,068.97" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$62,068.97" "$62,068.97" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS838 DRG MS838 CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT INPATIENT ONLY "$48,284.50" "$35,730.53" $0.00 "$31,012.72" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$31,012.72" "$31,012.72" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS839 DRG MS839 CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC INPATIENT ONLY "$46,940.94" "$34,736.30" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS840 DRG MS840 LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC INPATIENT ONLY "$189,074.54" "$139,915.16" $0.00 "$34,299.15" $0.00 $0.00 "$33,279.73" "$33,279.73" $0.00 $0.00 $0.00 $0.00 $0.00 "$33,222.22" $0.00 "$22,689.83" $0.00 $0.00 "$34,299.15" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$28,807.13" "$28,807.13" "$34,299.15" $0.00 $0.00 $0.00 $0.00 $0.00 MS841 DRG MS841 LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC INPATIENT ONLY "$15,184.92" "$11,236.84" $0.00 "$22,689.83" $0.00 $0.00 "$22,244.93" "$22,244.93" $0.00 "$13,446.69" $0.00 $0.00 $0.00 $0.00 "$13,446.69" "$22,689.83" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$19,565.68" "$19,565.68" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS842 DRG MS842 LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC INPATIENT ONLY "$38,523.96" "$28,507.73" $0.00 "$21,645.35" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$21,645.35" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$20,614.66" $0.00 $0.00 $0.00 $0.00 $0.00 MS843 DRG MS843 OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC INPATIENT ONLY "$90,251.16" "$66,785.86" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS844 DRG MS844 OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC INPATIENT ONLY "$25,954.84" "$19,206.58" $0.00 "$22,057.74" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$22,057.74" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$21,007.37" $0.00 $0.00 $0.00 $0.00 $0.00 MS846 DRG MS846 CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC INPATIENT ONLY "$30,411.91" "$22,504.81" $0.00 "$30,090.51" $0.00 $0.00 "$29,500.50" "$29,500.50" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$30,090.51" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS847 DRG MS847 CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC INPATIENT ONLY "$31,407.44" "$23,241.51" $0.00 "$45,264.16" "$8,173.20" "$8,173.20" $0.00 $0.00 "$5,107.14" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$5,107.14" "$5,107.14" $0.00 "$19,402.95" "$45,264.16" "$34,827.46" "$13,190.98" "$5,107.14" "$13,190.98" $0.00 "$23,891.56" "$23,891.56" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS848 DRG MS848 CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC INPATIENT ONLY "$30,134.29" "$22,299.37" $0.00 "$22,966.96" "$12,259.80" "$12,259.80" $0.00 $0.00 "$7,545.81" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$15,484.50" "$15,484.50" $0.00 "$12,768.30" "$22,966.96" $0.00 "$9,837.86" "$15,484.50" "$9,837.86" $0.00 "$21,159.88" "$21,159.88" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS853 DRG MS853 INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC INPATIENT ONLY "$349,119.20" "$258,348.21" $0.00 "$565,069.81" "$17,269.35" "$17,269.35" "$45,338.71" "$45,338.71" $0.00 "$50,464.10" $0.00 $0.00 $0.00 "$45,250.00" "$52,987.33" "$46,245.48" $0.00 $0.00 "$48,645.14" "$463,756.79" "$565,069.81" "$228,902.42" "$140,496.05" $0.00 "$140,496.05" $0.00 "$54,782.85" "$54,782.85" "$46,328.70" $0.00 $0.00 $0.00 $0.00 $0.00 MS854 DRG MS854 INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC INPATIENT ONLY "$172,549.34" "$127,686.51" $0.00 "$28,571.70" $0.00 $0.00 "$25,699.83" "$25,699.83" $0.00 $0.00 $0.00 $0.00 $0.00 "$25,661.94" $0.00 "$26,213.83" $0.00 $0.00 "$28,571.70" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$27,211.14" $0.00 $0.00 $0.00 $0.00 $0.00 MS856 DRG MS856 POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC INPATIENT ONLY "$469,903.79" "$347,728.80" $0.00 "$49,287.63" "$21,079.29" "$21,079.29" "$43,241.35" "$43,241.35" $0.00 "$37,955.94" $0.00 $0.00 $0.00 $0.00 "$37,955.94" "$44,106.18" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$49,287.63" "$49,287.63" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS857 DRG MS857 POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC INPATIENT ONLY "$110,455.26" "$81,736.89" $0.00 "$409,840.86" "$90,864.72" "$90,864.72" "$25,563.20" "$25,563.20" $0.00 $0.00 $0.00 $0.00 "$30,135.69" "$26,369.16" $0.00 "$26,074.46" $0.00 $0.00 "$27,697.65" "$336,359.28" "$409,840.86" $0.00 "$88,518.80" $0.00 "$88,518.80" $0.00 "$53,140.71" "$53,140.71" "$26,378.71" $0.00 $0.00 $0.00 $0.00 $0.00 MS858 DRG MS858 POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$300,169.86" "$222,125.70" $0.00 "$206,438.96" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$20,090.46" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$206,438.96" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS862 DRG MS862 POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC INPATIENT ONLY "$41,178.47" "$30,472.07" $0.00 "$28,258.17" $0.00 $0.00 "$24,143.55" "$24,143.55" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$28,258.17" "$28,258.17" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS863 DRG MS863 POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC INPATIENT ONLY "$26,750.77" "$19,795.57" $0.00 "$20,554.34" $0.00 $0.00 "$18,033.63" "$18,033.63" $0.00 $0.00 $0.00 $0.00 $0.00 "$18,015.57" $0.00 "$18,394.30" $0.00 $0.00 "$20,554.34" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$19,575.56" $0.00 $0.00 $0.00 $0.00 $0.00 MS864 DRG MS864 FEVER AND INFLAMMATORY CONDITIONS INPATIENT ONLY "$19,333.68" "$14,306.92" $0.00 "$47,628.02" $0.00 $0.00 "$17,102.64" "$17,102.64" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$17,444.69" $0.00 $0.00 "$47,628.02" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$29,690.76" $0.00 $0.00 $0.00 $0.00 $0.00 MS865 DRG MS865 VIRAL ILLNESS WITH MCC INPATIENT ONLY "$14,496.05" "$10,727.08" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS866 DRG MS866 VIRAL ILLNESS WITHOUT MCC INPATIENT ONLY "$34,717.88" "$25,691.23" $0.00 "$26,124.06" $0.00 $0.00 $0.00 $0.00 $0.00 "$6,802.34" $0.00 $0.00 $0.00 $0.00 "$6,802.34" $0.00 $0.00 $0.00 $0.00 "$10,651.53" "$26,124.06" $0.00 "$8,206.90" $0.00 "$8,206.90" $0.00 "$19,831.20" "$19,831.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS867 DRG MS867 OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC INPATIENT ONLY "$63,136.42" "$46,720.95" $0.00 "$112,359.77" "$112,359.77" "$112,359.77" "$26,492.82" "$26,492.82" $0.00 "$16,751.36" $0.00 $0.00 $0.00 $0.00 "$16,751.36" "$27,022.68" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS868 DRG MS868 OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC INPATIENT ONLY "$30,779.69" "$22,776.97" $0.00 "$69,508.29" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$16,175.27" "$69,508.29" $0.00 "$10,996.66" $0.00 "$10,996.66" $0.00 "$22,103.93" "$22,103.93" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS869 DRG MS869 OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC INPATIENT ONLY "$15,619.28" "$11,558.27" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS870 DRG MS870 SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS INPATIENT ONLY "$342,603.24" "$253,526.40" $0.00 "$437,462.32" "$222,926.65" "$222,926.65" "$55,492.21" "$55,492.21" $0.00 "$53,865.50" $0.00 $0.00 "$387,832.33" "$55,377.23" "$56,558.79" "$56,602.05" $0.00 $0.00 "$57,021.26" "$359,028.42" "$437,462.32" $0.00 "$105,276.97" $0.00 "$105,276.97" $0.00 "$64,792.48" "$64,792.48" "$71,505.46" $0.00 $0.00 $0.00 $0.00 $0.00 MS871 DRG MS871 SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC INPATIENT ONLY "$99,302.62" "$73,483.94" $0.00 "$69,468.99" "$49,039.20" "$49,039.20" "$23,974.45" "$23,974.45" "$16,130.58" "$17,521.48" $0.00 $0.00 "$16,742.05" "$23,941.03" "$17,521.48" "$24,453.94" "$28,083.00" "$28,083.00" "$26,556.42" "$27,518.59" "$69,468.99" "$47,721.33" "$18,708.37" "$28,083.00" "$18,708.37" "$16,770.40" "$28,386.40" "$28,386.40" "$30,367.39" "$17,608.91" $0.00 $0.00 $0.00 $0.00 MS872 DRG MS872 SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC INPATIENT ONLY "$39,146.17" "$28,968.17" $0.00 "$25,653.18" "$12,923.98" "$12,923.98" "$18,136.48" "$18,136.48" "$9,397.01" "$9,417.32" $0.00 $0.00 $0.00 "$18,118.16" "$9,417.32" "$18,499.21" "$15,394.50" "$15,394.50" "$20,904.90" "$7,127.66" "$25,653.18" $0.00 "$10,418.26" "$15,394.50" "$10,418.26" "$6,963.04" "$21,632.73" "$21,632.73" "$19,909.43" "$7,410.63" $0.00 $0.00 $0.00 $0.00 MS876 DRG MS876 O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS INPATIENT ONLY "$147,401.50" "$109,077.11" $0.00 "$46,127.21" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$46,127.21" "$46,127.21" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS880 DRG MS880 ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION INPATIENT ONLY "$37,752.98" "$27,937.21" $0.00 "$50,316.83" "$4,100.18" "$4,100.18" "$17,019.80" "$17,019.80" $0.00 "$5,575.59" $0.00 $0.00 "$10,045.23" $0.00 "$5,854.37" "$17,360.20" $0.00 $0.00 "$50,316.83" "$7,019.44" "$50,065.60" "$33,004.93" "$8,589.83" $0.00 "$8,589.83" "$5,603.41" "$20,143.15" "$20,143.15" "$49,378.27" "$5,883.58" $0.00 $0.00 $0.00 $0.00 MS881 DRG MS881 DEPRESSIVE NEUROSES INPATIENT ONLY "$19,663.24" "$14,550.80" $0.00 "$19,401.50" "$12,913.95" "$12,913.95" $0.00 $0.00 "$5,769.59" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$12,030.00" "$12,030.00" "$19,401.50" $0.00 $0.00 "$5,860.95" $0.00 "$12,030.00" $0.00 "$4,833.71" $0.00 $0.00 "$18,477.62" "$5,075.40" $0.00 $0.00 $0.00 $0.00 MS882 DRG MS882 NEUROSES EXCEPT DEPRESSIVE INPATIENT ONLY "$20,130.12" "$14,896.29" $0.00 "$12,620.55" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$12,620.55" "$12,620.55" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS883 DRG MS883 DISORDERS OF PERSONALITY AND IMPULSE CONTROL INPATIENT ONLY "$21,248.40" "$15,723.82" $0.00 "$22,936.59" "$16,782.35" "$16,782.35" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$22,936.59" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$7,140.10" "$7,183.84" "$7,183.84" "$21,844.37" "$7,497.10" $0.00 $0.00 $0.00 $0.00 MS884 DRG MS884 ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY INPATIENT ONLY "$38,142.56" "$28,225.49" $0.00 "$69,644.94" "$69,644.94" "$69,644.94" "$21,042.01" "$21,042.01" "$9,624.61" "$10,098.77" $0.00 $0.00 $0.00 "$21,016.17" "$10,603.71" "$21,462.85" "$25,969.50" "$25,969.50" "$23,629.52" $0.00 $0.00 $0.00 $0.00 "$25,969.50" $0.00 $0.00 "$24,888.70" "$24,888.70" "$22,504.30" $0.00 $0.00 $0.00 $0.00 $0.00 MS885 DRG MS885 PSYCHOSES INPATIENT ONLY "$27,249.99" "$20,164.99" $0.00 "$19,607.18" "$5,534.55" "$5,534.55" "$19,607.18" "$19,607.18" "$9,119.42" "$6,833.56" $0.00 $0.00 "$6,556.06" "$15,565.31" "$6,833.56" "$8,019.25" "$18,591.00" "$18,591.00" "$9,222.35" "$12,800.77" "$14,261.38" "$11,383.39" "$9,000.00" "$18,591.00" "$9,000.00" "$6,540.64" "$4,851.36" "$4,851.36" "$8,783.19" "$6,867.66" $0.00 $0.00 $0.00 $0.00 MS886 DRG MS886 BEHAVIORAL AND DEVELOPMENTAL DISORDERS INPATIENT ONLY "$18,427.83" "$13,636.59" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS887 DRG MS887 OTHER MENTAL DISORDER DIAGNOSES INPATIENT ONLY "$41,241.49" "$30,518.70" $0.00 "$57,514.90" $0.00 $0.00 $0.00 $0.00 "$8,326.81" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$16,197.00" "$16,197.00" $0.00 "$16,044.03" "$57,514.90" $0.00 "$10,907.45" "$16,197.00" "$10,907.45" $0.00 "$22,031.26" "$22,031.26" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS894 DRG MS894 "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA" INPATIENT ONLY "$21,543.05" "$15,941.86" $0.00 "$17,768.90" "$4,086.60" "$4,086.60" "$16,734.90" "$16,734.90" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$17,069.60" $0.00 $0.00 "$17,768.90" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$12,658.39" $0.00 $0.00 "$16,922.76" "$13,291.30" $0.00 $0.00 $0.00 $0.00 MS896 DRG MS896 "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC" INPATIENT ONLY "$49,326.69" "$36,501.75" $0.00 "$40,932.53" "$4,136.10" "$4,136.10" "$23,340.19" "$23,340.19" "$13,606.38" $0.00 $0.00 $0.00 $0.00 "$23,308.40" $0.00 "$23,806.99" "$25,043.92" "$25,043.92" "$25,554.59" "$15,138.49" "$40,932.53" $0.00 "$17,238.80" "$25,043.92" "$17,238.80" $0.00 "$27,189.19" "$27,189.19" "$24,337.70" $0.00 $0.00 $0.00 $0.00 $0.00 MS897 DRG MS897 "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC" INPATIENT ONLY "$30,584.36" "$22,632.43" $0.00 "$41,618.80" "$12,711.30" "$12,711.30" "$16,782.58" "$16,782.58" "$6,163.22" $0.00 $0.00 $0.00 "$10,638.97" "$16,746.23" $0.00 $0.00 "$12,405.00" "$12,405.00" "$19,418.55" "$41,618.80" "$32,962.09" "$14,261.88" "$41,618.80" "$12,405.00" "$41,618.80" "$6,496.27" "$4,824.19" "$4,824.19" "$18,493.86" "$6,821.08" $0.00 $0.00 $0.00 $0.00 MS901 DRG MS901 WOUND DEBRIDEMENTS FOR INJURIES WITH MCC INPATIENT ONLY "$368,092.68" "$272,388.58" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS902 DRG MS902 WOUND DEBRIDEMENTS FOR INJURIES WITH CC INPATIENT ONLY "$122,560.83" "$90,695.01" $0.00 "$116,932.68" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$116,932.68" $0.00 $0.00 $0.00 $0.00 $0.00 "$27,243.90" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$29,207.95" "$29,207.95" "$25,946.57" $0.00 $0.00 $0.00 $0.00 $0.00 MS903 DRG MS903 WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC INPATIENT ONLY "$69,084.55" "$51,122.57" $0.00 "$342,304.46" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$280,931.70" "$342,304.46" $0.00 "$66,795.60" $0.00 "$66,795.60" $0.00 "$40,627.42" "$40,627.42" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS904 DRG MS904 SKIN GRAFTS FOR INJURIES WITH CC/MCC INPATIENT ONLY "$587,248.63" "$434,563.99" $0.00 "$136,934.37" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$112,383.02" "$136,934.37" $0.00 "$35,459.97" $0.00 "$35,459.97" "$23,848.01" "$42,033.36" "$42,033.36" $0.00 "$25,040.40" $0.00 $0.00 $0.00 $0.00 MS905 DRG MS905 SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC INPATIENT ONLY "$130,398.68" "$96,495.02" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS906 DRG MS906 HAND PROCEDURES FOR INJURIES INPATIENT ONLY "$173,990.59" "$128,753.04" $0.00 "$201,237.38" "$184,096.43" "$184,096.43" "$23,502.39" "$23,502.39" "$49,807.27" $0.00 $0.00 $0.00 "$13,855.47" $0.00 $0.00 "$23,972.44" "$201,237.38" "$201,237.38" $0.00 "$128,086.32" "$156,068.25" $0.00 "$17,451.31" "$201,237.38" "$17,451.31" $0.00 "$27,362.32" "$27,362.32" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS907 DRG MS907 OTHER O.R. PROCEDURES FOR INJURIES WITH MCC INPATIENT ONLY "$314,976.43" "$233,082.56" $0.00 "$388,246.60" "$217,751.34" "$217,751.34" "$38,301.96" "$38,301.96" $0.00 "$30,419.81" $0.00 $0.00 "$98,592.46" "$38,231.45" "$41,160.33" "$39,068.00" $0.00 $0.00 $0.00 "$205,770.40" "$250,723.31" $0.00 "$45,461.07" $0.00 "$45,461.07" "$39,395.94" "$388,246.60" "$388,246.60" $0.00 "$41,365.72" $0.00 $0.00 $0.00 $0.00 MS908 DRG MS908 OTHER O.R. PROCEDURES FOR INJURIES WITH CC INPATIENT ONLY "$152,656.61" "$112,965.89" $0.00 "$182,669.21" $0.00 $0.00 "$25,204.31" "$25,204.31" $0.00 "$34,521.96" $0.00 $0.00 "$71,256.39" $0.00 "$34,521.96" "$25,708.40" $0.00 $0.00 "$27,901.30" "$97,496.00" "$118,795.12" "$182,669.21" "$20,681.15" $0.00 "$20,681.15" "$15,861.25" "$29,993.55" "$29,993.55" "$26,572.67" "$16,654.30" $0.00 $0.00 $0.00 $0.00 MS909 DRG MS909 OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC INPATIENT ONLY "$15,837.75" "$11,719.94" $0.00 "$58,188.52" $0.00 $0.00 $0.00 $0.00 $0.00 "$11,600.88" $0.00 $0.00 $0.00 $0.00 "$11,600.88" $0.00 $0.00 $0.00 "$22,814.25" "$47,755.73" "$58,188.52" $0.00 "$13,219.05" $0.00 "$13,219.05" "$15,861.25" "$23,914.43" "$23,914.43" "$21,727.86" "$16,654.30" $0.00 $0.00 $0.00 $0.00 MS913 DRG MS913 TRAUMATIC INJURY WITH MCC INPATIENT ONLY "$58,527.66" "$43,310.47" $0.00 "$35,408.42" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$35,408.42" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$25,201.47" "$25,201.47" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS914 DRG MS914 TRAUMATIC INJURY WITHOUT MCC INPATIENT ONLY "$50,070.45" "$37,052.13" $0.00 "$42,063.45" "$19,477.40" "$19,477.40" "$17,174.42" "$17,174.42" $0.00 $0.00 $0.00 $0.00 "$12,315.97" "$17,158.58" $0.00 "$17,517.91" $0.00 $0.00 $0.00 "$34,521.77" "$42,063.45" $0.00 "$8,637.95" $0.00 "$8,637.95" $0.00 "$20,182.36" "$20,182.36" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS915 DRG MS915 ALLERGIC REACTIONS WITH MCC INPATIENT ONLY "$13,523.90" "$10,007.69" $0.00 "$27,685.69" $0.00 $0.00 "$27,685.69" "$27,685.69" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$22,782.56" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS916 DRG MS916 ALLERGIC REACTIONS WITHOUT MCC INPATIENT ONLY "$18,896.57" "$13,983.46" $0.00 "$18,988.45" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$18,129.72" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$18,316.33" "$18,316.33" "$18,988.45" $0.00 $0.00 $0.00 $0.00 $0.00 MS917 DRG MS917 POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC INPATIENT ONLY "$41,023.80" "$30,357.61" $0.00 "$51,372.18" "$17,715.70" "$17,715.70" "$21,257.33" "$21,257.33" "$12,541.54" "$6,253.67" $0.00 $0.00 "$20,090.46" "$21,230.93" "$11,939.58" "$21,682.48" "$22,177.50" "$22,177.50" "$23,801.74" "$17,979.07" "$51,372.18" $0.00 "$14,667.56" "$22,177.50" "$14,667.56" "$11,427.78" "$25,094.49" "$25,094.49" "$22,668.32" "$11,999.16" $0.00 $0.00 $0.00 $0.00 MS918 DRG MS918 POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC INPATIENT ONLY "$26,175.61" "$19,369.95" $0.00 "$24,709.73" "$4,453.30" "$4,453.30" "$24,709.73" "$24,709.73" "$2,488.34" "$6,225.23" $0.00 $0.00 "$3,348.41" "$24,675.25" "$6,225.23" "$23,946.92" "$11,044.46" "$11,044.46" "$19,160.25" "$3,729.06" "$12,112.06" "$13,648.19" "$6,834.23" "$11,044.46" "$6,834.23" "$5,958.38" "$19,547.84" "$19,547.84" "$18,247.86" "$6,256.30" $0.00 $0.00 $0.00 $0.00 MS919 DRG MS919 COMPLICATIONS OF TREATMENT WITH MCC INPATIENT ONLY "$64,348.49" "$47,617.88" $0.00 "$69,950.28" "$5,749.93" "$5,749.93" "$23,780.51" "$23,780.51" $0.00 "$11,257.45" $0.00 $0.00 $0.00 "$23,747.59" "$11,257.45" "$24,256.12" $0.00 $0.00 "$26,276.23" "$26,914.05" "$69,950.28" $0.00 "$18,297.37" $0.00 "$18,297.37" $0.00 "$28,051.57" "$28,051.57" "$25,024.98" $0.00 $0.00 $0.00 $0.00 $0.00 MS920 DRG MS920 COMPLICATIONS OF TREATMENT WITH CC INPATIENT ONLY "$24,394.92" "$18,052.24" $0.00 "$28,277.30" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$20,687.60" "$14,855.59" "$28,277.30" $0.00 "$10,099.48" $0.00 "$10,099.48" $0.00 "$21,373.04" "$21,373.04" "$19,702.48" $0.00 $0.00 $0.00 $0.00 $0.00 MS921 DRG MS921 COMPLICATIONS OF TREATMENT WITHOUT CC/MCC INPATIENT ONLY "$34,245.21" "$25,341.46" $0.00 "$18,521.98" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$10,898.00" $0.00 $0.00 $0.00 $0.00 $0.00 "$18,521.98" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$17,639.98" $0.00 $0.00 $0.00 $0.00 $0.00 MS922 DRG MS922 "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC" INPATIENT ONLY "$72,838.99" "$53,900.85" $0.00 "$61,719.57" $0.00 $0.00 "$22,014.43" "$22,014.43" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$22,454.72" $0.00 $0.00 $0.00 "$3,753.19" "$61,719.57" $0.00 "$16,074.98" $0.00 "$16,074.98" "$1,335.32" "$26,241.08" "$26,241.08" $0.00 "$1,421.16" $0.00 $0.00 $0.00 $0.00 MS923 DRG MS923 "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC" INPATIENT ONLY "$20,532.46" "$15,194.02" $0.00 "$17,890.29" $0.00 $0.00 "$17,539.50" "$17,539.50" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$17,890.29" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS927 DRG MS927 EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT INPATIENT ONLY "$756,935.58" "$560,132.33" $0.00 "$636,813.54" "$636,813.54" "$636,813.54" $0.00 $0.00 $0.00 "$122,178.14" $0.00 $0.00 $0.00 $0.00 "$128,287.10" $0.00 $0.00 $0.00 $0.00 "$300,908.95" "$366,645.98" $0.00 "$199,919.71" $0.00 "$199,919.71" "$122,787.92" "$176,013.20" "$176,013.20" $0.00 "$128,927.26" $0.00 $0.00 $0.00 $0.00 MS928 DRG MS928 FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC INPATIENT ONLY "$201,318.93" "$148,976.01" $0.00 "$242,850.15" "$242,850.15" "$242,850.15" "$56,131.28" "$56,131.28" "$48,038.28" "$21,161.06" $0.00 $0.00 "$198,393.73" "$56,014.65" "$21,161.06" "$57,253.91" "$81,797.38" "$81,797.38" "$56,136.99" "$103,838.89" "$126,523.70" $0.00 "$62,099.56" "$81,797.38" "$62,099.56" "$20,253.97" "$63,735.75" "$63,735.75" "$53,463.80" "$21,266.66" $0.00 $0.00 $0.00 $0.00 MS929 DRG MS929 FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC INPATIENT ONLY "$110,995.12" "$82,136.39" $0.00 "$94,527.37" "$67,878.36" "$67,878.36" "$31,853.89" "$31,853.89" "$20,836.22" "$9,637.44" $0.00 $0.00 "$94,527.37" $0.00 "$10,119.31" "$32,490.97" "$68,724.23" "$68,724.23" "$33,904.08" "$52,200.82" "$63,604.70" "$60,897.37" "$62,099.56" "$68,724.23" "$62,099.56" "$9,685.54" "$63,735.75" "$63,735.75" "$32,289.60" "$10,169.81" $0.00 $0.00 $0.00 $0.00 MS933 DRG MS933 EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT INPATIENT ONLY "$239,425.50" "$177,174.87" $0.00 "$35,261.93" $0.00 $0.00 "$26,670.86" "$26,670.86" $0.00 "$34,672.09" $0.00 $0.00 $0.00 $0.00 "$34,672.09" "$27,204.28" $0.00 $0.00 "$35,261.93" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$33,582.79" $0.00 $0.00 $0.00 $0.00 $0.00 MS934 DRG MS934 FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY INPATIENT ONLY "$21,519.08" "$15,924.12" $0.00 "$32,060.98" "$32,060.98" "$32,060.98" "$28,769.31" "$28,769.31" $0.00 "$9,096.60" $0.00 $0.00 "$24,196.92" "$24,413.93" "$9,096.60" $516.01 $0.00 $0.00 "$26,170.31" "$4,043.26" "$16,532.51" $0.00 "$18,141.99" $0.00 "$18,141.99" "$2,220.06" "$27,924.99" "$27,924.99" "$24,924.10" "$2,362.77" $0.00 $0.00 $0.00 $0.00 MS935 DRG MS935 NON-EXTENSIVE BURNS INPATIENT ONLY "$41,960.79" "$31,050.98" $0.00 "$28,925.37" "$15,650.93" "$15,650.93" "$24,393.38" "$24,393.38" $0.00 "$8,178.90" $0.00 $0.00 "$8,531.60" "$24,358.86" "$8,178.90" "$24,881.25" $0.00 $0.00 "$27,007.44" "$15,169.68" "$18,483.67" "$7,817.30" "$19,369.96" $0.00 "$19,369.96" "$2,410.65" "$28,925.37" "$28,925.37" "$25,721.37" "$2,565.61" $0.00 $0.00 $0.00 $0.00 MS940 DRG MS940 O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC INPATIENT ONLY "$94,350.10" "$69,819.07" $0.00 "$27,930.95" "$20,433.00" "$20,433.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$27,930.95" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$27,930.95" $0.00 $0.00 $0.00 $0.00 $0.00 MS941 DRG MS941 O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC INPATIENT ONLY "$142,894.44" "$105,741.89" $0.00 "$26,996.52" $0.00 $0.00 "$24,325.75" "$24,325.75" $0.00 $0.00 $0.00 $0.00 $0.00 "$24,291.39" $0.00 $0.00 $0.00 $0.00 "$26,996.52" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$25,710.97" $0.00 $0.00 $0.00 $0.00 $0.00 MS947 DRG MS947 SIGNS AND SYMPTOMS WITH MCC INPATIENT ONLY "$47,907.15" "$35,451.29" $0.00 "$22,923.01" $0.00 $0.00 "$19,293.84" "$19,293.84" $0.00 $0.00 $0.00 $0.00 $0.00 "$19,272.53" $0.00 "$19,679.72" $0.00 $0.00 "$21,984.63" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$13,833.77" "$22,923.01" "$22,923.01" "$20,937.74" "$14,525.45" $0.00 $0.00 $0.00 $0.00 MS948 DRG MS948 SIGNS AND SYMPTOMS WITHOUT MCC INPATIENT ONLY "$17,563.09" "$12,996.69" $0.00 "$31,248.40" "$20,433.00" "$20,433.00" "$16,485.64" "$16,485.64" $0.00 "$7,783.43" $0.00 $0.00 $0.00 $0.00 "$7,783.43" "$16,815.35" $0.00 $0.00 "$19,130.18" "$3,483.39" "$31,248.40" "$17,149.01" "$6,011.26" $0.00 "$6,011.26" $0.00 "$19,511.90" "$19,511.90" "$18,219.22" $0.00 $0.00 $0.00 $0.00 $0.00 MS950 DRG MS950 AFTERCARE WITHOUT CC/MCC INPATIENT ONLY "$41,083.74" "$30,401.97" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS951 DRG MS951 OTHER FACTORS INFLUENCING HEALTH STATUS INPATIENT ONLY "$55,607.65" "$41,149.66" $0.00 "$20,033.73" $0.00 $0.00 "$17,291.74" "$17,291.74" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$20,033.73" "$20,033.73" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS955 DRG MS955 CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA INPATIENT ONLY "$622,062.28" "$460,326.09" $0.00 "$646,654.77" "$646,654.77" "$646,654.77" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$74,994.21" $0.00 $0.00 "$74,415.79" "$361,311.27" "$440,243.88" "$303,884.19" "$105,609.45" $0.00 "$105,609.45" "$53,840.04" "$62,801.51" "$62,801.51" "$70,872.18" "$56,532.01" $0.00 $0.00 $0.00 $0.00 MS956 DRG MS956 "LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA" INPATIENT ONLY "$228,564.82" "$169,137.97" $0.00 "$294,666.51" "$147,277.43" "$147,277.43" "$37,624.23" "$37,624.23" $0.00 "$117,843.05" $0.00 $0.00 "$294,666.51" $0.00 "$116,900.81" "$38,376.71" $0.00 $0.00 "$40,613.44" "$174,522.63" "$212,649.13" "$278,577.75" "$39,328.35" $0.00 "$39,328.35" "$84,114.71" "$45,184.81" "$45,184.81" "$38,679.47" "$53,545.64" $0.00 $0.00 $0.00 $0.00 MS957 DRG MS957 OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC INPATIENT ONLY "$302,297.61" "$223,700.23" $0.00 "$661,644.95" "$303,164.25" "$303,164.25" "$62,268.78" "$62,268.78" "$144,907.91" "$80,138.05" $0.00 $0.00 "$432,660.03" $0.00 "$80,138.05" "$63,514.16" "$422,490.48" "$422,490.48" "$65,286.01" "$278,370.30" "$339,183.51" "$661,644.95" "$78,684.59" "$422,490.48" "$78,684.59" "$76,702.83" "$74,669.01" "$74,669.01" "$62,177.15" "$80,537.94" $0.00 $0.00 $0.00 $0.00 MS958 DRG MS958 OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC INPATIENT ONLY "$285,394.08" "$211,191.62" $0.00 "$243,925.14" "$243,925.14" "$243,925.14" "$40,437.04" "$40,437.04" $0.00 "$33,019.28" $0.00 $0.00 "$171,009.88" "$40,424.16" "$33,019.28" "$41,247.95" $0.00 $0.00 "$42,442.17" "$130,622.58" "$159,158.58" "$179,708.38" "$42,010.85" $0.00 "$42,010.85" "$31,603.87" "$47,370.16" "$47,370.16" "$40,421.11" "$33,184.05" $0.00 $0.00 $0.00 $0.00 MS959 DRG MS959 OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC INPATIENT ONLY "$198,587.32" "$146,954.62" $0.00 "$121,673.30" "$117,245.71" "$117,245.71" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$99,858.13" "$121,673.30" $0.00 "$28,073.07" $0.00 "$28,073.07" "$19,466.16" "$36,015.52" "$36,015.52" $0.00 "$20,439.46" $0.00 $0.00 $0.00 $0.00 MS963 DRG MS963 OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC INPATIENT ONLY "$102,608.59" "$75,930.36" $0.00 "$206,519.43" "$29,282.40" "$29,282.40" "$29,893.87" "$29,893.87" "$24,162.84" $0.00 $0.00 $0.00 "$206,519.43" "$37,659.87" $0.00 "$30,491.75" "$40,948.50" "$40,948.50" "$32,425.24" "$64,598.93" "$78,711.32" "$113,231.89" "$27,317.23" "$40,948.50" "$27,317.23" "$29,432.41" "$35,399.75" "$35,399.75" "$30,881.18" "$30,904.01" $0.00 $0.00 $0.00 $0.00 MS964 DRG MS964 OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC INPATIENT ONLY "$102,198.77" "$75,627.09" $0.00 "$62,293.64" "$19,477.40" "$19,477.40" "$21,349.12" "$21,349.12" "$13,182.41" "$17,222.51" $0.00 $0.00 "$13,855.47" "$21,322.49" "$17,222.51" "$21,776.10" "$22,377.00" "$22,377.00" $0.00 "$51,124.83" "$62,293.64" "$33,880.61" "$14,971.29" "$22,377.00" "$14,971.29" "$4,058.08" "$25,341.92" "$25,341.92" $0.00 "$4,318.93" $0.00 $0.00 $0.00 $0.00 MS965 DRG MS965 OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC INPATIENT ONLY "$110,685.47" "$81,907.25" $0.00 "$46,222.92" "$15,656.33" "$15,656.33" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,618.49" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$37,935.50" "$46,222.92" $0.00 "$9,193.30" $0.00 "$9,193.30" "$8,185.98" "$20,634.78" "$20,634.78" $0.00 "$8,595.28" $0.00 $0.00 $0.00 $0.00 MS969 DRG MS969 HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC INPATIENT ONLY "$353,828.86" "$261,833.36" $0.00 "$67,855.17" $0.00 $0.00 "$67,855.17" "$67,855.17" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS970 DRG MS970 HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC INPATIENT ONLY "$159,032.74" "$117,684.23" $0.00 "$36,966.90" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$36,966.90" "$36,966.90" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS974 DRG MS974 HIV WITH MAJOR RELATED CONDITION WITH MCC INPATIENT ONLY "$73,178.08" "$54,151.78" $0.00 "$583,583.70" "$35,613.99" "$35,613.99" "$37,227.84" "$37,227.84" $0.00 $0.00 $0.00 $0.00 "$583,583.70" "$29,573.90" $0.00 "$30,214.39" $0.00 $0.00 "$27,554.25" "$13,595.40" "$64,425.98" $0.00 "$26,803.98" $0.00 "$26,803.98" $0.00 "$44,204.35" "$44,204.35" "$27,554.25" $0.00 $0.00 $0.00 $0.00 $0.00 MS975 DRG MS975 HIV WITH MAJOR RELATED CONDITION WITH CC INPATIENT ONLY "$51,952.99" "$38,445.21" $0.00 "$25,529.20" "$16,572.15" "$16,572.15" "$19,901.89" "$19,901.89" $0.00 "$11,270.70" $0.00 $0.00 $0.00 $0.00 "$11,270.70" "$20,299.93" $0.00 $0.00 "$22,973.48" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$24,104.72" "$24,104.72" "$25,529.20" $0.00 $0.00 $0.00 $0.00 $0.00 MS976 DRG MS976 HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC INPATIENT ONLY "$22,299.59" "$16,501.70" $0.00 "$36,779.40" "$36,779.40" "$36,779.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$23,764.33" "$23,764.33" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS977 DRG MS977 HIV WITH OR WITHOUT OTHER RELATED CONDITION INPATIENT ONLY "$39,015.42" "$28,871.41" $0.00 "$23,765.79" "$8,399.10" "$8,399.10" "$20,193.12" "$20,193.12" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$20,596.98" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$23,765.79" "$23,765.79" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS981 DRG MS981 EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC INPATIENT ONLY "$206,905.41" "$153,110.00" $0.00 "$389,857.92" "$389,857.92" "$389,857.92" "$47,995.46" "$47,995.46" $0.00 "$47,997.68" $0.00 $0.00 $0.00 "$42,818.02" "$47,997.68" "$56,112.45" $0.00 $0.00 "$44,568.12" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$47,748.94" "$47,748.94" "$42,445.83" $0.00 $0.00 $0.00 $0.00 $0.00 MS982 DRG MS982 EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC INPATIENT ONLY "$141,904.77" "$105,009.53" $0.00 "$52,490.00" $0.00 $0.00 "$28,559.81" "$28,559.81" $0.00 $0.00 $0.00 $0.00 "$52,490.00" "$28,514.50" $0.00 "$26,802.53" $0.00 $0.00 "$30,463.26" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$20,815.40" "$33,055.16" "$33,055.16" "$29,012.63" "$21,856.15" $0.00 $0.00 $0.00 $0.00 MS983 DRG MS983 EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC INPATIENT ONLY "$191,096.52" "$141,411.42" $0.00 "$84,648.54" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$7,786.79" "$84,648.54" $0.00 "$16,410.80" $0.00 "$16,410.80" $0.00 "$26,514.63" "$26,514.63" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS987 DRG MS987 NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC INPATIENT ONLY "$116,755.62" "$86,399.16" $0.00 "$130,780.00" "$111,671.84" "$111,671.84" "$33,662.08" "$33,662.08" $0.00 $0.00 $0.00 $0.00 "$130,780.00" $0.00 $0.00 "$83,339.54" $0.00 $0.00 "$62,005.18" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$129,871.79" "$129,871.79" "$59,052.55" $0.00 $0.00 $0.00 $0.00 $0.00 MS988 DRG MS988 NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC INPATIENT ONLY "$301,856.57" "$223,373.86" $0.00 "$101,160.63" $0.00 $0.00 "$22,830.18" "$22,830.18" $0.00 $0.00 $0.00 $0.00 $0.00 "$22,799.71" $0.00 "$23,286.78" $0.00 $0.00 "$24,328.59" "$83,023.25" "$101,160.63" $0.00 "$17,224.76" $0.00 "$17,224.76" $0.00 "$27,177.75" "$27,177.75" "$24,328.59" $0.00 $0.00 $0.00 $0.00 $0.00 MS989 DRG MS989 NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC INPATIENT ONLY "$35,912.44" "$26,575.21" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 MS998 DRG MS998 PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS INPATIENT ONLY "$72,064.04" "$53,327.39" $0.00 "$6,092.76" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$5,802.63" $0.00 $0.00 $0.00 "$6,092.76" $0.00 $0.00 $0.00 $0.00 MS999 DRG MS999 UNGROUPABLE INPATIENT ONLY "$30,544.21" "$22,602.72" $0.00 "$62,801.51" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$62,801.51" "$62,801.51" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 812 EAP CPT® 00812 ANESTHESIA LOWER INTST ENDOSCOPIC PX SCR COLSC BOTH IP/OP $625.00 $462.50 $0.00 $500.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $446.06 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $312.50 $495.00 $500.00 $0.00 $0.00 $0.00 $97.81 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 813 EAP CPT® 00813 ANESTHESIA COMBINED UPPER&LOWER GI ENDOSCOPIC PX BOTH IP/OP $625.00 $462.50 $0.00 $500.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $446.06 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $312.50 $495.00 $500.00 $0.00 $0.00 $0.00 $97.81 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 11200 EAP CPT®11200 "PR DEBRIDEMENT OF NAILS, 6 OR MORE" BOTH IP/OP $255.00 $188.70 $0.00 $255.00 255 $255.00 $174.88 $174.88 175.86 53.15 255 $255.00 $255.00 $172.08 53.14 $111.85 $113.00 $113.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 11976 EAP CPT®11976 CHEM CAUTERY GRANULATN TISSUE BOTH IP/OP $408.00 $301.92 $0.00 $606.01 $408.00 $408.00 $606.01 $606.01 $408.00 $0.00 $408.00 $408.00 $408.00 $596.11 $85.03 $387.47 $408.00 $408.00 $175.24 $305.00 $241.56 $244.00 $243.48 $408.00 $243.48 $37.05 $38.57 $38.57 $48.56 $166.90 $0.00 $0.00 $0.00 $0.00 11981 EAP CPT®11981 PR REMOVAL OF BREAST LESION BOTH IP/OP $286.00 $211.64 $0.00 $286.00 286 $286.00 $109.81 $109.81 110.43 59.61 $0.00 $0.00 $0.00 $107.30 59.6 $69.74 $113.00 $113.00 $286.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 11983 EAP CPT®11983 INJECT CARPAL TUNNEL BOTH IP/OP $402.00 $297.48 $0.00 $402.00 $402.00 $402.00 $264.30 $264.30 $265.79 $83.79 $0.00 $0.00 $0.00 $258.98 $83.78 $168.34 $113.00 $113.00 $262.54 $284.00 $224.93 $227.20 $284.00 $402.00 $284.00 $44.45 $59.49 $59.49 $45.21 $250.04 $0.00 $0.00 $0.00 $0.00 17250 EAP CPT® 17250 INJECT TENDON ORIGIN/INSERT BOTH IP/OP $256.00 $189.44 $0.00 $262.54 $256.00 $256.00 $174.88 $174.88 $175.86 $53.36 $0.00 $0.00 $0.00 $172.08 $53.35 $111.85 $113.00 $113.00 $262.54 $202.00 $159.98 $161.60 $202.00 $0.00 $202.00 $0.00 $41.47 $41.47 $32.16 $250.04 $0.00 $0.00 $0.00 $0.00 20526 EAP CPT® 20526 "INJECT TRIGGER POINTS, > 3" BOTH IP/OP $232.00 $171.68 $0.00 $262.54 $232.00 $232.00 $254.43 $254.43 $232.00 $48.35 $0.00 $0.00 $0.00 $250.31 $48.35 $162.70 $232.00 $232.00 $262.54 $230.00 $182.16 $184.00 $230.00 $0.00 $230.00 $66.56 $45.07 $45.07 $36.62 $250.04 $0.00 $0.00 $0.00 $0.00 20550 EAP CPT® 20550 ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US BOTH IP/OP $162.00 $119.88 $28.97 $262.54 $162.00 $162.00 $254.43 $254.43 $162.00 $33.76 $162.00 $162.00 $162.00 $250.31 $33.76 $162.70 $162.00 $162.00 $262.54 $182.00 $144.14 $145.60 $182.00 $162.00 $182.00 $54.79 $37.50 $37.50 $28.97 $250.04 $0.00 $0.00 $0.00 $0.00 20551 EAP CPT® 20551 ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT BOTH IP/OP $164.00 $121.36 $0.00 $274.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $262.54 $274.00 $217.01 $219.20 $274.00 $0.00 $274.00 $69.40 $47.60 $47.60 $43.62 $250.04 $0.00 $0.00 $0.00 $0.00 20552 EAP CPT® 20552 ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US BOTH IP/OP $152.00 $112.48 $0.00 $626.89 $0.00 $0.00 $0.00 $0.00 $0.00 $31.68 $0.00 $0.00 $0.00 $250.31 $31.68 $162.70 $152.00 $152.00 $626.89 $303.00 $239.98 $242.40 $303.00 $152.00 $303.00 $76.82 $54.81 $54.81 $48.24 $597.04 $0.00 $0.00 $0.00 $0.00 20553 EAP CPT® 20553 PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US BOTH IP/OP $175.00 $129.50 $0.00 $0.00 0 $0.00 $0.00 $0.00 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 20600 EAP CPT® 20600 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US BOTH IP/OP $150.00 $111.00 $31.26 $262.54 $150.00 $150.00 $254.43 $254.43 $150.00 $31.26 $150.00 $150.00 $150.00 $250.31 $31.26 $162.70 $150.00 $150.00 $262.54 $223.00 $176.62 $178.40 $223.00 $150.00 $223.00 $70.76 $47.59 $47.59 $35.50 $250.04 $0.00 $0.00 $0.00 $0.00 20604 EAP CPT® 20604 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US BOTH IP/OP $232.00 $171.68 $0.00 $338.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $250.31 $48.35 $162.70 $113.00 $113.00 $262.54 $338.00 $267.70 $270.40 $338.00 $0.00 $338.00 $88.61 $62.38 $62.38 $53.81 $250.04 $0.00 $0.00 $0.00 $0.00 20606 EAP CPT® 20606 CLOSED RX METATARSAL FX BOTH IP/OP $252.00 $186.48 $0.00 $790.00 $252.00 $252.00 $618.38 $618.38 $252.00 $52.52 $0.00 $0.00 $0.00 $608.20 $52.52 $395.33 $113.00 $113.00 $216.27 $790.00 $625.68 $632.00 $300.48 $0.00 $300.48 $214.80 $210.83 $210.83 $125.77 $205.98 $0.00 $0.00 $0.00 $0.00 20610 EAP CPT® 20610 PR SHOULDER SCOPE BONE SHAVING BOTH IP/OP $183.00 $135.42 $0.00 $254.43 183 $183.00 $254.43 $254.43 183 38.14 183 $183.00 $183.00 $250.31 38.14 $162.70 $183.00 $183.00 $183.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 20610 EAP CPT®20610 CLOSED RX TOE FX BOTH IP/OP $183.00 $135.42 $0.00 $346.90 $183.00 $183.00 $254.43 $254.43 $183.00 $38.14 $183.00 $183.00 $183.00 $250.31 $38.14 $162.70 $183.00 $183.00 $0.00 $0.00 $346.90 $0.00 $0.00 $183.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 20611 EAP CPT® 20611 PR ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG BOTH IP/OP $281.00 $207.94 $0.00 $281.00 281 $281.00 $254.43 $254.43 255.86 58.57 $0.00 $0.00 $0.00 $250.31 58.56 $162.70 $113.00 $113.00 $281.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 20612 EAP CPT®20612 "PR CATHETER ASPIRATN,NASOTRACH" BOTH IP/OP $181.00 $133.94 $0.00 $254.43 181 $181.00 $254.43 $254.43 181 0 $0.00 $0.00 $0.00 $250.31 37.72 $162.70 $181.00 $181.00 $181.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25600 EAP CPT®25600 "PHLEB, VENIPUNCTURE" BOTH IP/OP $970.00 $717.80 $0.00 $202.15 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $197.62 $202.15 $128.45 $113.00 $113.00 $3.15 $5.50 $8.71 $8.80 $4.35 $0.00 $4.35 $1.72 $3.00 $3.00 $1.75 $3.00 $0.00 $0.00 $0.00 $0.00 28470 EAP CPT® 28470 PR INSERT NON-TUNNEL CV CATH BOTH IP/OP $620.00 $458.80 $0.00 $0.00 0 $0.00 $0.00 $0.00 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 28490 EAP CPT®28490 "REMOVE TONSILS/ADENOIDS,<12 Y/O" BOTH IP/OP $401.00 $296.74 $0.00 $401.00 401 $401.00 $200.72 $200.72 201.85 0 $0.00 $0.00 $0.00 $0.00 83.57 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 28510 EAP CPT® 28510 PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC BOTH IP/OP $340.00 $251.60 $0.00 $340.00 0 $0.00 $0.00 $0.00 0 0 $0.00 $0.00 $0.00 $0.00 70.86 $0.00 $0.00 $0.00 $340.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 36415 EAP CPT® 36415 PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD BOTH IP/OP $11.00 $8.14 $0.00 $7.15 5.97 $5.97 $3.00 $3.00 1.5 1.35 3.12 $3.12 $3.24 $3.00 2.29 $1.95 $6.51 $6.51 $7.15 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 43235 EAP CPT®43235 COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE BOTH IP/OP $867.00 $641.58 $0.00 "$1,530.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $775.94 $180.68 $504.36 $867.00 $867.00 "$1,007.17" "$1,530.00" "$1,211.76" "$1,224.00" "$1,399.33" $0.00 "$1,399.33" $353.17 $208.77 $208.77 $243.58 $959.21 $0.00 $0.00 $0.00 $0.00 43239 EAP CPT® 43239 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ BOTH IP/OP "$1,110.00 " $821.40 $0.00 "$1,598.00" "$1,110.00" "$1,110.00" $787.99 $787.99 $792.43 $0.00 "$1,110.00" "$1,110.00" "$1,110.00" $775.94 $231.32 $504.36 "$1,110.00" "$1,110.00" "$1,007.17" "$1,598.00" "$1,265.62" "$1,278.40" "$1,399.33" $0.00 "$1,399.33" $450.95 $265.02 $265.02 $254.40 $959.21 $0.00 $0.00 $0.00 $0.00 43239 EAP CPT®43239 PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ BOTH IP/OP "$1,110.00 " $821.40 $0.00 "$1,110.00" 1110 "$1,110.00" $787.99 $787.99 792.43 0 1110 "$1,110.00" "$1,110.00" $775.94 231.32 $504.36 "$1,110.00" "$1,110.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 43246 EAP CPT®43246 PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX BOTH IP/OP $557.00 $412.18 $0.00 "$1,581.72" 557 $557.00 "$1,581.72" "$1,581.72" 557 0 557 $557.00 $557.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 45330 EAP CPT® 45330 "PR LAP,CHOLECYSTECTOMY" BOTH IP/OP $542.00 $401.08 $0.00 $0.00 0 $0.00 $0.00 $0.00 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 45331 EAP CPT®45331 "PR REPAIR ING HERNIA,5+Y/O,REDUCIBL" BOTH IP/OP $844.00 $624.56 $0.00 $175.89 0 $0.00 $0.00 $0.00 0 0 $0.00 $0.00 $0.00 $0.00 175.89 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 45335 EAP CPT®45335 "PR BIOPSY OF PROSTATE,NEEDLE/PUNCH" BOTH IP/OP $860.00 $636.40 $0.00 $179.22 0 $0.00 $0.00 $0.00 0 0 $0.00 $0.00 $0.00 $0.00 179.22 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 45378 EAP CPT® 45378 "BIOPSY VULVA/PERINEUM,ONE LESN" BOTH IP/OP $984.00 $728.16 $0.00 $984.00 $984.00 $984.00 $772.82 $772.82 $777.17 $0.00 $984.00 $984.00 $984.00 $760.65 $205.07 $494.42 $984.00 $984.00 $640.34 $328.00 $259.78 $262.40 $328.00 $0.00 $328.00 $84.36 $63.10 $63.10 $52.22 $609.84 $0.00 $0.00 $0.00 $0.00 45378 EAP CPT®45378 "PR LAP,PROSTATECTOMY,RADICAL,W/NERVE SPARE,INCL ROBOTIC" BOTH IP/OP $984.00 $728.16 $0.00 $984.00 984 $984.00 $772.82 $772.82 777.17 0 984 $984.00 $984.00 $760.65 205.07 $494.42 $984.00 $984.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 45380 EAP CPT® 45380 "COLPOSCOPY,CERVIX W/ADJ VAGINA,W/BX" BOTH IP/OP "$1,268.00 " $938.32 $0.00 "$1,268.00" "$1,268.00" "$1,268.00" "$1,009.84" "$1,009.84" "$1,015.53" $0.00 "$1,268.00" "$1,268.00" "$1,268.00" $993.84 $264.25 $646.00 "$1,268.00" "$1,268.00" $271.52 $560.00 $443.52 $448.00 $377.23 $0.00 $377.23 $145.54 $115.02 $115.02 $89.15 $258.59 $0.00 $0.00 $0.00 $0.00 45380 EAP CPT®45380 "COLPOSC,CERVIX W/ADJ VAG,W/BX & CURRETAG" BOTH IP/OP "$1,268.00 " $938.32 $0.00 "$1,268.00" "$1,268.00" "$1,268.00" "$1,009.84" "$1,009.84" "$1,015.53" $0.00 "$1,268.00" "$1,268.00" "$1,268.00" $993.84 $264.25 $646.00 "$1,268.00" "$1,268.00" $271.52 $594.00 $470.45 $475.20 $377.23 $0.00 $377.23 $99.94 $140.25 $140.25 $94.56 $258.59 $0.00 $0.00 $0.00 $0.00 45381 EAP CPT®45381 "COLPOSCOPY,CERVIX W/ADJ VAGINA, CURETTAG" BOTH IP/OP "$1,294.00 " $957.56 $0.00 "$1,294.00" "$1,294.00" "$1,294.00" "$1,009.84" "$1,009.84" "$1,015.53" $0.00 "$1,294.00" "$1,294.00" "$1,294.00" $993.84 $269.67 $646.00 "$1,294.00" "$1,294.00" $271.52 $526.00 $416.59 $420.80 $377.23 $0.00 $377.23 $137.69 $106.36 $106.36 $83.74 $258.59 $0.00 $0.00 $0.00 $0.00 45385 EAP CPT® 45385 BIOPSY OF UTERUS LINING BOTH IP/OP "$1,318.00 " $975.32 $0.00 "$1,318.00" "$1,318.00" "$1,318.00" "$1,009.84" "$1,009.84" "$1,015.53" $0.00 "$1,318.00" "$1,318.00" "$1,318.00" $993.84 $274.67 $646.00 "$1,318.00" "$1,318.00" $166.54 $353.00 $279.58 $282.40 $231.38 $0.00 $231.38 $59.72 $67.07 $67.07 $56.20 $158.61 $0.00 $0.00 $0.00 $0.00 45385 EAP CPT®45385 BIOPSY/EXCIS CERVICAL LESN BOTH IP/OP "$1,318.00 " $975.32 $0.00 "$1,318.00" "$1,318.00" "$1,318.00" "$1,009.84" "$1,009.84" "$1,015.53" $0.00 "$1,318.00" "$1,318.00" "$1,318.00" $993.84 $274.67 $646.00 "$1,318.00" "$1,318.00" $640.34 $518.00 $410.26 $414.40 $518.00 $0.00 $518.00 $71.26 $78.23 $78.23 $82.47 $609.84 $0.00 $0.00 $0.00 $0.00 56605 EAP CPT® 56605 "PR OBSTETRICAL CARE,VAG DELIV ONLY" BOTH IP/OP $276.00 $204.24 $0.00 $617.38 276 $276.00 $617.38 $617.38 276 57.53 276 $276.00 $276.00 $607.07 57.52 $394.60 $276.00 $276.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 57454 EAP CPT® 57454 "PR FULL ROUT OBSTE CARE,CESAREAN DELIV" BOTH IP/OP $482.00 $356.68 $0.00 $0.00 0 $0.00 $0.00 $0.00 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 57455 EAP CPT® 57455 "PR ROUT OB CARE,VAG DELIV,PREV C-SEC" BOTH IP/OP $461.00 $341.14 $0.00 $0.00 0 $0.00 $0.00 $0.00 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 57456 EAP CPT® 57456 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN BOTH IP/OP $432.00 $319.68 $0.00 $0.00 0 $0.00 $0.00 $0.00 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 57500 EAP CPT® 57500 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN BOTH IP/OP $448.00 $331.52 $0.00 $617.38 448 $448.00 $617.38 $617.38 448 93.37 448 $448.00 $448.00 $607.07 93.36 $394.60 $448.00 $448.00 $448.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 57505 EAP CPT®57505 INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH BOTH IP/OP $449.00 $332.26 $0.00 $626.89 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $626.89 $275.00 $217.80 $220.00 $275.00 $0.00 $275.00 $85.27 $44.35 $44.35 $43.78 $597.04 $0.00 $0.00 $0.00 $0.00 58100 EAP CPT® 58100 "PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL" BOTH IP/OP $292.00 $216.08 $0.00 $292.00 292 $292.00 $165.90 $165.90 166.84 60.86 292 $292.00 $292.00 $163.24 60.85 $106.10 $113.00 $113.00 $292.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 58110 EAP CPT® 58110 "PR DISCISSION,2ND CATARACT,LASER" BOTH IP/OP $141.00 $104.34 $0.00 $0.00 0 $0.00 $0.00 $0.00 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 58300 EAP CPT® 58300 PR XCAPSL CTRC RMVL INSJ IO LENS PROSTH W/O ECP BOTH IP/OP $265.00 $196.10 $0.00 $265.00 265 $265.00 $0.00 $0.00 51.66 55.23 $0.00 $0.00 $0.00 $0.00 55.23 $0.00 $113.00 $113.00 $265.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 58301 EAP CPT® 58301 PR INJECT INTRAVITREAL PHARMCOLOGIC BOTH IP/OP $316.00 $233.84 $0.00 $316.00 316 $316.00 $274.65 $274.65 276.2 65.86 $0.00 $0.00 $0.00 $269.78 65.85 $175.35 $316.00 $316.00 $316.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 64450 EAP CPT® 64450 "PR CT ANGIO,HEAD COMBO,INCL IMAGE PROCESS" BOTH IP/OP $216.00 $159.84 $0.00 $618.38 216 $216.00 $618.38 $618.38 216 45.02 216 $216.00 $216.00 $608.20 45.01 $395.33 $216.00 $216.00 $216.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 69210 EAP CPT® 69210 CHG RADIOLOGIC EXAM CHEST 2 VIEWS BOTH IP/OP $134.00 $99.16 $0.00 $134.00 134 $134.00 $54.21 $54.21 54.51 27.93 $0.00 $0.00 $0.00 $53.35 27.93 $34.67 $113.00 $113.00 $134.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 70360 EAP CPT® 70360 "X-RAY RIBS, CHEST 4+ VW" BOTH IP/OP $90.00 $66.60 $18.76 $137.87 $63.70 $63.70 $78.77 $78.77 $79.21 $18.76 $45.06 $45.06 $46.80 $77.54 $18.76 $50.40 $53.24 $53.24 $112.41 $29.76 $98.21 $99.20 $124.00 $137.87 $124.00 $50.44 $35.30 $35.30 $19.74 $107.06 $0.00 $0.00 $0.00 $0.00 70450 EAP CPT® 70450 "CT SCAN,THORAX,W/O CONTRAST" BOTH IP/OP $313.00 $231.62 $55.40 $313.00 $313.00 $313.00 $106.02 $106.02 $106.62 $65.24 $313.00 $313.00 $313.00 $104.44 $65.23 $67.89 $313.00 $313.00 $112.41 $84.96 $280.37 $283.20 $156.18 $313.00 $156.18 $55.40 $101.21 $101.21 $56.36 $107.06 $0.00 $0.00 $0.00 $0.00 70450 EAP CPT®70450 "PR CT SCAN,THORAX,W/O CONTRAST" BOTH IP/OP $313.00 $231.62 $0.00 $313.00 313 $313.00 $106.02 $106.02 106.62 65.24 313 $313.00 $313.00 $104.44 65.23 $67.89 $313.00 $313.00 $313.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 70487 EAP CPT®70487 CAT SCAN OF CHEST CONTRAST BOTH IP/OP $451.00 $333.74 $0.00 $451.00 $451.00 $451.00 $173.95 $173.95 $174.93 $94.00 $451.00 $451.00 $451.00 $171.13 $93.99 $111.23 $451.00 $451.00 $202.33 $113.52 $374.62 $378.40 $281.11 $0.00 $281.11 $74.02 $135.06 $135.06 $75.30 $192.70 $0.00 $0.00 $0.00 $0.00 70491 EAP CPT®70491 "PR CT ANGIO, CHEST (NON-CORON), COMBO, INCL IMG PROC" BOTH IP/OP $550.00 $407.00 $0.00 $550.00 550 $550.00 $173.95 $173.95 174.93 114.63 550 $550.00 $550.00 $171.13 114.62 $111.23 $550.00 $550.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 70492 EAP CPT® 70492 "CT ANGIO, CHEST, COMBO, INCL IMAGE PROC" BOTH IP/OP $661.00 $489.14 $0.00 $509.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $202.33 $152.88 $504.50 $509.60 $281.11 $0.00 $281.11 $99.69 $214.30 $214.30 $101.41 $192.70 $0.00 $0.00 $0.00 $0.00 71045 EAP CPT®71045 CHG X-RAY THORACIC SPINE 2 VW BOTH IP/OP $74.00 $54.76 $0.00 $78.77 45.3 $45.30 $78.77 $78.77 74 15.42 26.8 $26.80 $27.83 $77.54 15.42 $50.40 $43.77 $43.77 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 71046 EAP CPT® 71046 X-RAY THOR-LUMB SP 2 VW BOTH IP/OP $96.00 $71.04 $13.05 $137.87 $69.46 $69.46 $78.77 $78.77 $79.21 $20.01 $49.06 $49.06 $50.94 $77.54 $20.01 $50.40 $56.78 $56.78 $80.04 $19.68 $64.94 $65.60 $82.00 $137.87 $82.00 $36.61 $23.41 $23.41 $13.05 $76.23 $0.00 $0.00 $0.00 $0.00 71046 EAP CPT®71046 X-RAY THORACIC SPINE 2 VW BOTH IP/OP $96.00 $71.04 $12.10 $137.87 $69.46 $69.46 $78.77 $78.77 $79.21 $20.01 $49.06 $49.06 $50.94 $77.54 $20.01 $50.40 $56.78 $56.78 $112.41 $18.24 $60.19 $60.80 $76.00 $137.87 $76.00 $35.88 $21.61 $21.61 $12.10 $107.06 $0.00 $0.00 $0.00 $0.00 71110 EAP CPT®71110 CHG X-RAY LUMBAR SPINE 2/3 VW BOTH IP/OP $126.00 $93.24 $0.00 $169.61 85.46 $85.46 $106.02 $106.02 106.62 26.26 67.28 $67.28 $69.87 $104.44 26.26 $67.89 $74.53 $74.53 $169.61 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 71111 EAP CPT® 71111 X-RAY LUMBAR SPINE 2/3 VW BOTH IP/OP $150.00 $111.00 $0.00 $112.41 $109.64 $109.64 $106.02 $106.02 $106.62 $31.26 $88.90 $88.90 $92.32 $104.44 $31.26 $67.89 $88.73 $88.73 $112.41 $22.80 $75.24 $76.00 $95.00 $0.00 $95.00 $36.61 $27.01 $27.01 $15.12 $107.06 $0.00 $0.00 $0.00 $0.00 71250 EAP CPT® 71250 X-RAY LUMBAR SPINE 4 VW BOTH IP/OP $393.00 $290.82 $19.90 $393.00 $393.00 $393.00 $106.02 $106.02 $106.62 $81.91 $393.00 $393.00 $393.00 $104.44 $81.90 $67.89 $393.00 $393.00 $112.41 $30.00 $99.00 $100.00 $125.00 $393.00 $125.00 $50.44 $35.66 $35.66 $19.90 $107.06 $0.00 $0.00 $0.00 $0.00 71250 EAP CPT®71250 CHG X-RAY LUMBAR SPINE 4 VW BOTH IP/OP $393.00 $290.82 $0.00 $393.00 393 $393.00 $106.02 $106.02 106.62 81.91 393 $393.00 $393.00 $104.44 81.9 $67.89 $393.00 $393.00 $393.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 71260 EAP CPT® 71260 "CT SCAN,LUMBAR SPINE,W/O CONTRAST" BOTH IP/OP $494.00 $365.56 $0.00 $494.00 $494.00 $494.00 $173.95 $173.95 $174.93 $102.96 $494.00 $494.00 $494.00 $171.13 $102.95 $111.23 $494.00 $494.00 $112.41 $371.00 $293.83 $296.80 $156.18 $0.00 $156.18 $58.06 $105.89 $105.89 $59.06 $107.06 $0.00 $0.00 $0.00 $0.00 71260 EAP CPT®71260 "PR CT SCAN,CERVICAL SPINE,W/O CONTRAST" BOTH IP/OP $494.00 $365.56 $0.00 $494.00 494 $494.00 $173.95 $173.95 174.93 102.96 494 $494.00 $494.00 $171.13 102.95 $111.23 $494.00 $494.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 71275 EAP CPT®71275 "PR MRI, CERV SPINE" BOTH IP/OP $763.00 $564.62 $0.00 $0.00 0 $0.00 $0.00 $0.00 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 72040 EAP CPT®72040 CHG X-RAY PELVIS 1/2 VW BOTH IP/OP $113.00 $83.62 $0.00 $137.87 74.98 $74.98 $78.77 $78.77 79.21 23.55 62.89 $62.89 $65.31 $77.54 23.55 $50.40 $66.84 $66.84 $137.87 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 72050 EAP CPT® 72050 PR CT SCAN OF PELVIS CONTRAST BOTH IP/OP $152.00 $112.48 $0.00 $106.62 103.2 $103.20 $106.02 $106.02 106.62 31.68 89.81 $89.81 $93.27 $104.44 31.68 $67.89 $89.91 $89.91 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 72052 EAP CPT® 72052 X-RAY SACRUM/COCCYX 2+ VW BOTH IP/OP $177.00 $130.98 $0.00 $104.70 $0.00 $0.00 $0.00 $0.00 $0.00 $36.89 $0.00 $0.00 $0.00 $104.44 $36.89 $67.89 $104.70 $104.70 $80.04 $18.96 $62.57 $63.20 $79.00 $0.00 $79.00 $30.55 $22.69 $22.69 $12.58 $76.23 $0.00 $0.00 $0.00 $0.00 72070 EAP CPT® 72070 CHG X-RAY SHOULDER 2+ VW BOTH IP/OP $94.00 $69.56 $0.00 $169.61 77.4 $77.40 $106.02 $106.02 94 19.59 55.63 $55.63 $57.77 $104.44 19.59 $67.89 $55.60 $55.60 $169.61 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 72070 EAP CPT®72070 X-RAY CLAVICLE BOTH IP/OP $94.00 $69.56 $12.90 $169.61 $77.40 $77.40 $106.02 $106.02 $94.00 $19.59 $55.63 $55.63 $57.77 $104.44 $19.59 $67.89 $55.60 $55.60 $80.04 $19.44 $64.15 $64.80 $81.00 $169.61 $81.00 $27.72 $23.05 $23.05 $12.90 $76.23 $0.00 $0.00 $0.00 $0.00 72080 EAP CPT® 72080 X-RAY SHOULDER 2+ VW BOTH IP/OP $100.00 $74.00 $0.00 $83.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $80.04 $19.92 $65.74 $66.40 $83.00 $0.00 $83.00 $30.90 $23.77 $23.77 $13.21 $76.23 $0.00 $0.00 $0.00 $0.00 72100 EAP CPT® 72100 X-RAY HUMERUS BOTH IP/OP $114.00 $84.36 $12.90 $169.61 $79.81 $79.81 $106.02 $106.02 $106.62 $23.76 $67.44 $67.44 $70.04 $104.44 $23.76 $67.89 $67.43 $67.43 $80.04 $19.44 $64.15 $64.80 $81.00 $169.61 $81.00 $30.55 $23.05 $23.05 $12.90 $76.23 $0.00 $0.00 $0.00 $0.00 72100 EAP CPT®72100 CHG X-RAY HUMERUS BOTH IP/OP $114.00 $84.36 $0.00 $169.61 79.81 $79.81 $106.02 $106.02 106.62 23.76 67.44 $67.44 $70.04 $104.44 23.76 $67.89 $67.43 $67.43 $169.61 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 72110 EAP CPT® 72110 X-RAY ELBOW 2 VW BOTH IP/OP $147.00 $108.78 $0.00 $169.61 $111.25 $111.25 $106.02 $106.02 $106.62 $0.00 $94.35 $94.35 $97.98 $0.00 $0.00 $0.00 $0.00 $0.00 $80.04 $17.04 $56.23 $56.80 $71.00 $169.61 $71.00 $27.38 $20.17 $20.17 $11.30 $76.23 $0.00 $0.00 $0.00 $0.00 72110 EAP CPT®72110 CHG X-RAY ELBOW 2 VW BOTH IP/OP $147.00 $108.78 $0.00 $169.61 111.25 $111.25 $106.02 $106.02 106.62 0 94.35 $94.35 $97.98 $0.00 $0.00 $0.00 $0.00 $0.00 $169.61 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 72114 EAP CPT®72114 X-RAY ELBOW 3+ VW BOTH IP/OP $177.00 $130.98 $12.42 $169.61 $141.08 $141.08 $106.02 $106.02 $106.62 $36.89 $127.92 $127.92 $132.84 $104.44 $36.89 $67.89 $104.70 $104.70 $80.04 $18.72 $61.78 $62.40 $78.00 $169.61 $78.00 $30.55 $22.33 $22.33 $12.42 $76.23 $0.00 $0.00 $0.00 $0.00 72125 EAP CPT®72125 CHG X-RAY FOREARM 2 VW BOTH IP/OP $385.00 $284.90 $0.00 $385.00 385 $385.00 $106.02 $106.02 106.62 80.24 385 $385.00 $385.00 $104.44 80.23 $67.89 $385.00 $385.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 72131 EAP CPT® 72131 X-RAY FOREARM 2 VW BOTH IP/OP $383.00 $283.42 $0.00 $383.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $80.04 $17.28 $57.02 $57.60 $72.00 $383.00 $72.00 $27.72 $20.53 $20.53 $11.46 $76.23 $0.00 $0.00 $0.00 $0.00 72170 EAP CPT®72170 X-RAY WRIST 3+ VW BOTH IP/OP $80.00 $59.20 $0.00 $169.61 $72.57 $72.57 $106.02 $106.02 $80.00 $0.00 $42.34 $42.34 $43.97 $0.00 $0.00 $0.00 $0.00 $0.00 $80.04 $25.44 $83.95 $84.80 $106.00 $169.61 $106.00 $28.79 $30.25 $30.25 $16.88 $76.23 $0.00 $0.00 $0.00 $0.00 72190 EAP CPT®72190 X-RAY HAND 2 VW BOTH IP/OP $121.00 $89.54 $0.00 $112.41 $86.28 $86.28 $106.02 $106.02 $106.62 $25.22 $70.16 $70.16 $72.86 $104.44 $25.22 $67.89 $71.57 $71.57 $112.41 $18.48 $60.98 $61.60 $77.00 $0.00 $77.00 $27.37 $21.97 $21.97 $12.26 $107.06 $0.00 $0.00 $0.00 $0.00 72220 EAP CPT® 72220 X-RAY HAND 3+ VW BOTH IP/OP $93.00 $68.82 $0.00 $137.87 $63.70 $63.70 $78.77 $78.77 $79.21 $0.00 $51.11 $51.11 $53.07 $0.00 $0.00 $0.00 $0.00 $0.00 $80.04 $22.08 $72.86 $73.60 $92.00 $137.87 $92.00 $28.79 $26.29 $26.29 $14.65 $76.23 $0.00 $0.00 $0.00 $0.00 73000 EAP CPT® 73000 CHG RADEX HIP UNILATERAL WITH PELVIS 1 VIEW BOTH IP/OP $92.00 $68.08 $0.00 $137.87 62.88 $62.88 $78.77 $78.77 79.21 19.18 46.88 $46.88 $48.69 $77.54 19.17 $50.40 $54.42 $54.42 $137.87 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 73030 EAP CPT® 73030 RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS BOTH IP/OP $99.00 $73.26 $19.10 $137.87 $66.11 $66.11 $78.77 $78.77 $79.21 $20.63 $50.19 $50.19 $52.12 $77.54 $20.63 $50.40 $58.56 $58.56 $80.04 $28.80 $95.04 $96.00 $111.21 $137.87 $111.21 $39.45 $34.22 $34.22 $19.10 $76.23 $0.00 $0.00 $0.00 $0.00 73030 EAP CPT®73030 CHG RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS BOTH IP/OP $99.00 $73.26 $0.00 $137.87 66.11 $66.11 $78.77 $78.77 79.21 20.63 50.19 $50.19 $52.12 $77.54 20.63 $50.40 $58.56 $58.56 $137.87 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 73060 EAP CPT® 73060 RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS BOTH IP/OP $91.00 $67.34 $18.96 $137.87 $66.11 $66.11 $78.77 $78.77 $79.21 $18.97 $50.19 $50.19 $52.12 $77.54 $18.96 $50.40 $53.83 $53.83 $112.41 $31.44 $103.75 $104.80 $131.00 $137.87 $131.00 $46.58 $37.46 $37.46 $20.86 $107.06 $0.00 $0.00 $0.00 $0.00 73060 EAP CPT®73060 RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS BOTH IP/OP $91.00 $67.34 $16.08 $137.87 $66.11 $66.11 $78.77 $78.77 $79.21 $18.97 $50.19 $50.19 $52.12 $77.54 $18.96 $50.40 $53.83 $53.83 $112.41 $24.24 $79.99 $80.80 $101.00 $137.87 $101.00 $37.75 $28.81 $28.81 $16.08 $107.06 $0.00 $0.00 $0.00 $0.00 73070 EAP CPT® 73070 RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS BOTH IP/OP $83.00 $61.42 $14.17 $137.87 $62.09 $62.09 $78.77 $78.77 $79.21 $17.30 $46.88 $46.88 $48.69 $77.54 $17.30 $50.40 $49.09 $49.09 $80.04 $21.36 $70.49 $71.20 $89.00 $137.87 $89.00 $30.93 $25.57 $25.57 $14.17 $76.23 $0.00 $0.00 $0.00 $0.00 73070 EAP CPT®73070 CHG RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS BOTH IP/OP $83.00 $61.42 $0.00 $137.87 62.09 $62.09 $78.77 $78.77 79.21 17.3 46.88 $46.88 $48.69 $77.54 17.3 $50.40 $49.09 $49.09 $137.87 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 73080 EAP CPT® 73080 CHG X-RAY KNEE 1 OR 2 VIEW BOTH IP/OP $93.00 $68.82 $0.00 $137.87 70.96 $70.96 $78.77 $78.77 79.21 19.38 62.89 $62.89 $65.31 $77.54 19.38 $50.40 $55.01 $55.01 $137.87 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 73090 EAP CPT® 73090 X-RAY KNEE 3 VIEW BOTH IP/OP $83.00 $61.42 $16.72 $137.87 $58.87 $58.87 $78.77 $78.77 $79.21 $17.30 $46.88 $46.88 $48.69 $77.54 $17.30 $50.40 $49.09 $49.09 $80.04 $25.20 $83.16 $84.00 $105.00 $137.87 $105.00 $31.26 $29.89 $29.89 $16.72 $76.23 $0.00 $0.00 $0.00 $0.00 73090 EAP CPT®73090 X-RAY KNEE 1 OR 2 VIEW BOTH IP/OP $83.00 $61.42 $17.30 $137.87 $58.87 $58.87 $78.77 $78.77 $79.21 $17.30 $46.88 $46.88 $48.69 $77.54 $17.30 $50.40 $49.09 $49.09 $80.04 $31.68 $69.70 $105.60 $111.21 $137.87 $111.21 $28.43 $25.21 $25.21 $21.01 $76.23 $0.00 $0.00 $0.00 $0.00 73100 EAP CPT® 73100 X-RAY KNEE 4+ VIEW BOTH IP/OP $97.00 $71.78 $18.31 $137.87 $66.11 $66.11 $78.77 $78.77 $79.21 $20.22 $48.68 $48.68 $50.55 $77.54 $20.21 $50.40 $57.38 $57.38 $112.41 $27.60 $91.08 $92.00 $115.00 $137.87 $115.00 $34.81 $32.78 $32.78 $18.31 $107.06 $0.00 $0.00 $0.00 $0.00 73110 EAP CPT® 73110 "X-RAY TIB + FIB, 2VW" BOTH IP/OP $117.00 $86.58 $12.58 $137.87 $80.63 $80.63 $78.77 $78.77 $79.21 $24.39 $61.39 $61.39 $63.75 $77.54 $24.38 $50.40 $69.21 $69.21 $80.04 $18.96 $62.57 $63.20 $79.00 $137.87 $79.00 $28.43 $22.69 $22.69 $12.58 $76.23 $0.00 $0.00 $0.00 $0.00 73110 EAP CPT®73110 "CHG X-RAY TIB + FIB, 2VW" BOTH IP/OP $117.00 $86.58 $0.00 $137.87 80.63 $80.63 $78.77 $78.77 79.21 24.39 61.39 $61.39 $63.75 $77.54 24.38 $50.40 $69.21 $69.21 $137.87 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 73120 EAP CPT® 73120 CHG X-RAY ANKLE 2 VW BOTH IP/OP $89.00 $65.86 $0.00 $169.61 59.66 $59.66 $106.02 $106.02 89 18.55 45.96 $45.96 $47.73 $104.44 18.55 $67.89 $52.64 $52.64 $169.61 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 73130 EAP CPT® 73130 CHG X-RAY ANKLE 3+ VW BOTH IP/OP $105.00 $77.70 $0.00 $137.87 70.14 $70.14 $78.77 $78.77 79.21 21.88 54.14 $54.14 $56.22 $77.54 21.88 $50.40 $62.11 $62.11 $137.87 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 73130 EAP CPT®73130 X-RAY ANKLE 2 VW BOTH IP/OP $105.00 $77.70 $13.05 $137.87 $70.14 $70.14 $78.77 $78.77 $79.21 $21.88 $54.14 $54.14 $56.22 $77.54 $21.88 $50.40 $62.11 $62.11 $80.04 $19.68 $64.94 $65.60 $82.00 $137.87 $82.00 $27.37 $23.41 $23.41 $13.05 $76.23 $0.00 $0.00 $0.00 $0.00 73140 EAP CPT®73140 X-RAY ANKLE 3+ VW BOTH IP/OP $107.00 $79.18 $14.65 $137.87 $71.76 $71.76 $78.77 $78.77 $79.21 $22.30 $53.24 $53.24 $55.29 $77.54 $22.30 $50.40 $63.29 $63.29 $80.04 $22.08 $72.86 $73.60 $92.00 $137.87 $92.00 $28.79 $26.29 $26.29 $14.65 $76.23 $0.00 $0.00 $0.00 $0.00 73200 EAP CPT®73200 CHG X-RAY FOOT 2 VW BOTH IP/OP $451.00 $333.74 $0.00 $815.94 451 $451.00 $106.02 $106.02 106.62 0 785.72 $785.72 $815.94 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 73501 EAP CPT®73501 X-RAY FOOT 2 VW BOTH IP/OP $93.00 $68.82 $11.30 $137.87 $67.72 $67.72 $78.77 $78.77 $79.21 $19.38 $50.89 $50.89 $52.84 $77.54 $19.38 $50.40 $55.01 $55.01 $80.04 $17.04 $56.23 $56.80 $71.00 $137.87 $71.00 $27.37 $20.17 $20.17 $11.30 $76.23 $0.00 $0.00 $0.00 $0.00 73502 EAP CPT® 73502 X-RAY FOOT 3+ VW BOTH IP/OP $134.00 $99.16 $13.69 $137.87 $94.33 $94.33 $78.77 $78.77 $79.21 $27.93 $75.00 $75.00 $77.89 $77.54 $27.93 $50.40 $79.26 $79.26 $80.04 $20.64 $68.11 $68.80 $86.00 $137.87 $86.00 $28.79 $24.49 $24.49 $13.69 $76.23 $0.00 $0.00 $0.00 $0.00 73502 EAP CPT®73502 CHG X-RAY FOOT 3+ VW BOTH IP/OP $134.00 $99.16 $0.00 $137.87 94.33 $94.33 $78.77 $78.77 79.21 27.93 75 $75.00 $77.89 $77.54 27.93 $50.40 $79.26 $79.26 $137.87 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 73521 EAP CPT® 73521 X-RAY TOE(S) BOTH IP/OP $118.00 $87.32 $12.10 $169.61 $90.29 $90.29 $106.02 $106.02 $106.62 $24.59 $70.54 $70.54 $73.26 $104.44 $24.59 $67.89 $69.80 $69.80 $80.04 $18.24 $60.19 $60.80 $76.00 $169.61 $76.00 $23.09 $21.61 $21.61 $12.10 $76.23 $0.00 $0.00 $0.00 $0.00 73522 EAP CPT® 73522 "CT SCAN,LOWER EXTREMITY,W/O CONTRAST" BOTH IP/OP $153.00 $113.22 $31.89 $371.00 $111.25 $111.25 $106.02 $106.02 $106.62 $31.89 $83.92 $83.92 $87.15 $104.44 $31.89 $67.89 $90.50 $90.50 $112.41 $371.00 $293.83 $296.80 $156.18 $169.61 $156.18 $58.06 $105.89 $105.89 $59.06 $107.06 $0.00 $0.00 $0.00 $0.00 73552 EAP CPT®73552 "PR MRI LOWER EXTREM JT, W/O CONTRAST" BOTH IP/OP $101.00 $74.74 $0.00 $137.87 74.18 $74.18 $78.77 $78.77 79.21 21.05 57.14 $57.14 $59.34 $77.54 21.05 $50.40 $59.74 $59.74 $137.87 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 73560 EAP CPT® 73560 RADIOLOGIC EXAM COMPLETE ACUTE ABDOMEN SERIES BOTH IP/OP $98.00 $72.52 $0.00 $137.87 $70.14 $70.14 $78.77 $78.77 $79.21 $20.43 $47.79 $47.79 $49.63 $77.54 $20.42 $50.40 $57.97 $57.97 $112.41 $27.60 $91.08 $92.00 $115.00 $137.87 $115.00 $44.36 $32.78 $32.78 $0.00 $107.06 $0.00 $0.00 $0.00 $0.00 73560 EAP CPT®73560 CHG RADIOLOGIC EXAM COMPLETE ACUTE ABDOMEN SERIES BOTH IP/OP $98.00 $72.52 $0.00 $137.87 70.14 $70.14 $78.77 $78.77 79.21 20.43 47.79 $47.79 $49.63 $77.54 20.42 $50.40 $57.97 $57.97 $137.87 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 73562 EAP CPT® 73562 "CT SCAN,ABDOMEN,W/O CONTRAST" BOTH IP/OP $117.00 $86.58 $24.38 $316.00 $81.42 $81.42 $78.77 $78.77 $79.21 $24.39 $60.18 $60.18 $62.50 $77.54 $24.38 $50.40 $69.21 $69.21 $112.41 $316.00 $250.27 $252.80 $156.18 $137.87 $156.18 $49.45 $90.40 $90.40 $50.31 $107.06 $0.00 $0.00 $0.00 $0.00 73564 EAP CPT® 73564 CT SCAN OF ABDOMEN CONTRAST BOTH IP/OP $132.00 $97.68 $27.51 $637.00 $90.29 $90.29 $106.02 $106.02 $106.62 $27.51 $69.25 $69.25 $71.92 $104.44 $27.51 $67.89 $78.08 $78.08 $202.33 $637.00 $504.50 $509.60 $281.11 $169.61 $281.11 $99.69 $185.49 $185.49 $101.41 $192.70 $0.00 $0.00 $0.00 $0.00 73590 EAP CPT® 73590 PR CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMGES BOTH IP/OP $90.00 $66.60 $0.00 $137.87 65.31 $65.31 $78.77 $78.77 79.21 18.76 45.06 $45.06 $46.80 $77.54 18.76 $50.40 $53.24 $53.24 $137.87 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 73590 EAP CPT®73590 CT SCAN OF ABDOMEN COMBO BOTH IP/OP $90.00 $66.60 $18.76 $637.00 $65.31 $65.31 $78.77 $78.77 $79.21 $18.76 $45.06 $45.06 $46.80 $77.54 $18.76 $50.40 $53.24 $53.24 $202.33 $637.00 $504.50 $509.60 $281.11 $137.87 $281.11 $99.69 $211.06 $211.06 $101.41 $192.70 $0.00 $0.00 $0.00 $0.00 73600 EAP CPT® 73600 "CHG CT SCAN,ABDOMENT AND PELVIS,W/O CONTRAST" BOTH IP/OP $92.00 $68.08 $0.00 $137.87 67.72 $67.72 $78.77 $78.77 79.21 19.18 45.96 $45.96 $47.73 $77.54 19.17 $50.40 $54.42 $54.42 $137.87 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 73600 EAP CPT®73600 CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMGES BOTH IP/OP $92.00 $68.08 $19.17 $836.80 $67.72 $67.72 $78.77 $78.77 $79.21 $19.18 $45.96 $45.96 $47.73 $77.54 $19.17 $50.40 $54.42 $54.42 $387.01 $251.04 $828.43 $836.80 $537.70 $137.87 $537.70 $163.70 $298.94 $298.94 $166.52 $368.58 $0.00 $0.00 $0.00 $0.00 73610 EAP CPT® 73610 "CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST" BOTH IP/OP $105.00 $77.70 $0.00 $137.87 71.76 $71.76 $78.77 $78.77 79.21 21.88 54.14 $54.14 $56.22 $77.54 21.88 $50.40 $62.11 $62.11 $137.87 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 73610 EAP CPT®73610 "CT SCAN,ABDOMENT AND PELVIS,W/O CONTRAST" BOTH IP/OP $105.00 $77.70 $0.00 $315.22 $71.76 $71.76 $78.77 $78.77 $79.21 $21.88 $54.14 $54.14 $56.22 $77.54 $21.88 $50.40 $62.11 $62.11 $0.00 $95.52 $315.22 $0.00 $0.00 $137.87 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 73620 EAP CPT® 73620 "PR MRI, ABDOMEN, COMBO" BOTH IP/OP $81.00 $59.94 $0.00 $137.87 58.87 $58.87 $78.77 $78.77 79.21 16.88 44.15 $44.15 $45.85 $77.54 16.88 $50.40 $47.91 $47.91 $137.87 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 73620 EAP CPT®73620 "CT SCAN,ABDOMENT AND PELVIS,W CONTRAST" BOTH IP/OP $81.00 $59.94 $0.00 $661.32 $58.87 $58.87 $78.77 $78.77 $79.21 $16.88 $44.15 $44.15 $45.85 $77.54 $16.88 $50.40 $47.91 $47.91 $0.00 $200.40 $661.32 $0.00 $0.00 $137.87 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 73630 EAP CPT® 73630 "US,HEAD/NECK TISSUES,B-SCAN/REAL TIME" BOTH IP/OP $99.00 $73.26 $20.63 $248.80 $66.11 $66.11 $78.77 $78.77 $79.21 $20.63 $53.24 $53.24 $55.29 $77.54 $20.63 $50.40 $58.56 $58.56 $112.41 $74.64 $246.31 $248.80 $156.18 $137.87 $156.18 $82.37 $88.96 $88.96 $49.51 $107.06 $0.00 $0.00 $0.00 $0.00 73630 EAP CPT®73630 "US, HEAD/NECK TISSUES,REAL TIME" BOTH IP/OP $99.00 $73.26 $0.00 $137.87 66.11 $66.11 $78.77 $78.77 79.21 20.63 53.24 $53.24 $55.29 $77.54 20.63 $50.40 $58.56 $58.56 $137.87 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 73660 EAP CPT® 73660 CHG US BREAST UNI REAL TIME WITH IMAGE LIMITED BOTH IP/OP $83.00 $61.42 $0.00 $0.00 0 $0.00 $0.00 $0.00 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 73700 EAP CPT® 73700 "PR US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE" BOTH IP/OP $383.00 $283.42 $0.00 $383.00 383 $383.00 $106.02 $106.02 106.62 79.83 383 $383.00 $383.00 $104.44 79.82 $67.89 $383.00 $383.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 74018 EAP CPT®74018 "PR US, ABDOMEN LIMITED" BOTH IP/OP $86.00 $63.64 $0.00 $137.87 62.2 $62.20 $78.77 $78.77 79.21 17.92 45.51 $45.51 $47.26 $77.54 17.92 $50.40 $50.87 $50.87 $137.87 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 74022 EAP CPT® 74022 US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA BOTH IP/OP $143.00 $105.82 $29.80 $244.80 $101.59 $101.59 $106.02 $106.02 $106.62 $29.80 $79.08 $79.08 $82.12 $104.44 $29.80 $67.89 $84.58 $84.58 $112.41 $73.44 $242.35 $244.80 $156.18 $169.61 $156.18 $90.50 $87.52 $87.52 $48.72 $107.06 $0.00 $0.00 $0.00 $0.00 74022 EAP CPT®74022 SONO ABDOMEN LIMITED BOTH IP/OP $143.00 $105.82 $29.80 $175.20 $101.59 $101.59 $106.02 $106.02 $106.62 $29.80 $79.08 $79.08 $82.12 $104.44 $29.80 $67.89 $84.58 $84.58 $112.41 $52.56 $173.45 $175.20 $156.18 $169.61 $156.18 $83.78 $62.67 $62.67 $34.86 $107.06 $0.00 $0.00 $0.00 $0.00 74150 EAP CPT® 74150 "PR US,RETROPERIT,REAL TIME,COMPLETE" BOTH IP/OP $406.00 $300.44 $0.00 $406.00 406 $406.00 $106.02 $106.02 106.62 84.62 406 $406.00 $406.00 $104.44 84.61 $67.89 $406.00 $406.00 $406.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 74160 EAP CPT® 74160 "US,RETROPERIT, B-SCAN/REAL TIME,COMPLETE" BOTH IP/OP $691.00 $511.34 $0.00 $691.00 $691.00 $691.00 $173.95 $173.95 $174.93 $0.00 $691.00 $691.00 $691.00 $0.00 $0.00 $0.00 $0.00 $0.00 $112.41 $65.04 $214.63 $216.80 $156.18 $540.00 $156.18 $112.23 $77.44 $77.44 $43.14 $107.06 $0.00 $0.00 $0.00 $0.00 74170 EAP CPT® 74170 SONO ABD RETROPERITNL LTD BOTH IP/OP $708.00 $523.92 $0.00 $112.41 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $112.41 $25.44 $83.95 $84.80 $106.00 $0.00 $106.00 $83.43 $30.25 $30.25 $16.88 $107.06 $0.00 $0.00 $0.00 $0.00 74174 EAP CPT®74174 "CHG US, OB >/= 14 WKS, SNGL FETUS" BOTH IP/OP "$1,140.00 " $843.60 $0.00 "$1,140.00" 1140 "$1,140.00" $358.61 $358.61 360.63 237.6 785.72 $785.72 $815.94 $352.81 237.58 $229.33 "$1,106.00" "$1,106.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 74176 EAP CPT®74176 "CHG US,PREGNANT UTERUS,F/U,TRANSABD APP" BOTH IP/OP $242.00 $179.08 $0.00 $370.58 242 $242.00 $0.00 $0.00 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $370.58 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 74177 EAP CPT®74177 "CHG FETAL BIOPHYS PROF,W/O NST" BOTH IP/OP $920.00 $680.80 $0.00 $920.00 920 $920.00 $0.00 $0.00 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $920.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 74178 EAP CPT®74178 "CHG ECHOGRAPHY,TRANSVAGINAL" BOTH IP/OP "$1,030.00 " $762.20 $0.00 "$1,030.00" 1030 "$1,030.00" $0.00 $0.00 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,030.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 76536 EAP CPT® 76536 "ECHO,PELVIC (NONOBSTETRIC)" BOTH IP/OP $322.00 $238.28 $42.51 $266.85 $266.85 $266.85 $106.02 $106.02 $106.62 $67.11 $204.76 $204.76 $212.63 $104.44 $67.10 $67.89 $190.46 $190.46 $112.41 $64.08 $211.46 $213.60 $156.18 $183.00 $156.18 $92.96 $76.36 $76.36 $42.51 $107.06 $0.00 $0.00 $0.00 $0.00 76536 EAP CPT®76536 "PR US,PELVIC (NONOBSTETRIC),REAL TIME,COMPLETE" BOTH IP/OP $322.00 $238.28 $0.00 $266.85 266.85 $266.85 $106.02 $106.02 106.62 67.11 204.76 $204.76 $212.63 $104.44 67.1 $67.89 $190.46 $190.46 $183.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 76700 EAP CPT® 76700 "CHG US GUIDE, VASCULAR ACCESS" BOTH IP/OP $338.00 $250.12 $0.00 $280.53 280.53 $280.53 $106.02 $106.02 106.62 70.45 236.95 $236.95 $246.07 $104.44 70.44 $67.89 $199.93 $199.93 $169.61 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 76700 EAP CPT®76700 "US,EXTREMITY,NONVASCULAR,REAL-TIME IMAGE,LIMITED" BOTH IP/OP $338.00 $250.12 $0.00 $280.53 $280.53 $280.53 $106.02 $106.02 $106.62 $70.45 $236.95 $236.95 $246.07 $104.44 $70.44 $67.89 $199.93 $199.93 $0.00 $27.84 $91.87 $0.00 $0.00 $169.61 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 76705 EAP CPT® 76705 SCREENING DIGITAL BREAST TOMOSYNTHESIS BI BOTH IP/OP $252.00 $186.48 $14.01 $209.59 $209.59 $209.59 $106.02 $106.02 $106.62 $52.52 $182.05 $182.05 $189.05 $104.44 $52.52 $67.89 $149.06 $149.06 $26.75 $21.12 $69.70 $70.40 $25.21 $183.00 $25.21 $53.24 $25.21 $25.21 $14.01 $25.21 $0.00 $0.00 $0.00 $0.00 76705 EAP CPT®76705 SONO GUIDE NEEDLE BIOPSY BOTH IP/OP $252.00 $186.48 $0.00 $209.59 $209.59 $209.59 $106.02 $106.02 $106.62 $52.52 $182.05 $182.05 $189.05 $104.44 $52.52 $67.89 $149.06 $149.06 $0.00 $21.84 $72.07 $72.80 $0.00 $183.00 $0.00 $92.25 $25.93 $25.93 $14.49 $0.00 $0.00 $0.00 $0.00 $0.00 76706 EAP CPT® 76706 CHG SCREENING DIGITAL BREAST TOMOSYNTHESIS BI BOTH IP/OP $307.00 $227.18 $0.00 $214.45 214.45 $214.45 $106.02 $106.02 106.62 63.99 166.71 $166.71 $173.12 $104.44 63.98 $67.89 $181.59 $181.59 $169.61 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 76770 EAP CPT®76770 CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI BOTH IP/OP $313.00 $231.62 $0.00 $259.59 259.59 $259.59 $106.02 $106.02 106.62 65.24 231.49 $231.49 $240.40 $104.44 65.23 $67.89 $185.14 $185.14 $169.61 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 76775 EAP CPT® 76775 CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD BOTH IP/OP $165.00 $122.10 $0.00 $209.79 133.82 $133.82 $106.02 $106.02 106.62 34.39 202.02 $202.02 $209.79 $104.44 34.39 $67.89 $97.60 $97.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 76830 EAP CPT®76830 CHG DRUG SCREEN QUANT DIPROPYLACETIC ACID TOTAL BOTH IP/OP $345.00 $255.30 $0.00 $280.55 280.55 $280.55 $106.02 $106.02 106.62 71.91 211.68 $211.68 $219.82 $104.44 71.9 $67.89 $204.07 $204.07 $169.61 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 76856 EAP CPT®76856 ASSAY OF VANCOMYCIN BOTH IP/OP $305.00 $225.70 $0.00 $253.12 253.12 $253.12 $106.02 $106.02 106.62 63.57 212.59 $212.59 $220.76 $104.44 63.56 $67.89 $180.41 $180.41 $169.61 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 76857 EAP CPT®76857 URINALYSIS WITH MICROSCOPY BOTH IP/OP $136.00 $100.64 $3.17 $208.22 $110.46 $110.46 $106.02 $106.02 $106.62 $28.35 $200.51 $200.51 $208.22 $104.44 $28.34 $67.89 $80.44 $80.44 $3.33 $8.86 $8.71 $8.80 $4.60 $169.61 $4.60 $4.99 $3.17 $3.17 $3.49 $3.17 $0.00 $0.00 $0.00 $0.00 76870 EAP CPT® 76870 CHG URINALYSIS NONAUTO W/O SCOPE BOTH IP/OP $291.00 $215.34 $0.00 $223.60 156.39 $156.39 $106.02 $106.02 106.62 60.65 215.32 $215.32 $223.60 $104.44 60.64 $67.89 $172.13 $172.13 $169.61 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 76882 EAP CPT® 76882 URINALYSIS BOTH IP/OP $160.00 $118.40 $0.00 $106.62 $82.24 $82.24 $106.02 $106.02 $106.62 $10.15 $0.00 $0.00 $0.00 $104.44 $0.00 $67.89 $0.00 $0.00 $2.36 $6.28 $6.34 $6.40 $3.26 $104.00 $3.26 $3.55 $2.25 $2.25 $2.48 $2.25 $0.00 $0.00 $0.00 $0.00 76942 EAP CPT® 76942 URINE PREGNANCY TEST BOTH IP/OP $165.00 $122.10 $0.00 $389.47 137.83 $137.83 $0.00 $0.00 0 34.39 375.04 $375.04 $389.47 $0.00 34.39 $0.00 $97.60 $97.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 77063 EAP CPT® 77063 PREGNANCY TEST-URINE BOTH IP/OP $149.00 $110.26 $6.98 $149.00 $126.56 $126.56 $25.21 $25.21 $46.99 $31.06 $64.15 $64.15 $66.61 $25.21 $31.05 $16.39 $88.13 $88.13 $9.04 $17.68 $23.76 $24.00 $12.48 $149.00 $12.48 $9.97 $8.61 $8.61 $6.98 $8.61 $0.00 $0.00 $0.00 $0.00 77063 EAP CPT®77063 URINALYSIS VOLUME MEASURE BOTH IP/OP $149.00 $110.26 $0.00 $149.00 126.56 $126.56 $25.21 $25.21 46.99 31.06 64.15 $64.15 $66.61 $25.21 31.05 $16.39 $88.13 $88.13 $149.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 77067 EAP CPT®77067 "INSERT,IMPLANT CONTRACEPTIVE" BOTH IP/OP $366.00 $270.84 $0.00 $366.00 310.36 $310.36 $99.77 $99.77 113.86 76.28 249.62 $249.62 $259.22 $99.77 76.27 $64.85 $216.49 $216.49 $366.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 77080 EAP CPT® 77080 "ASPIRATION/INJ.,GANGION CYST" BOTH IP/OP $105.00 $77.70 $0.00 $169.61 93.51 $93.51 $106.02 $106.02 105 21.88 152.48 $152.48 $158.35 $104.44 21.88 $67.89 $62.11 $62.11 $169.61 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 77081 EAP CPT® 77081 TREAT FRACTURE RADIUS/ULNA BOTH IP/OP $88.00 $65.12 $0.00 $137.87 63.7 $63.70 $78.77 $78.77 79.21 0 48.21 $48.21 $50.07 $0.00 $0.00 $0.00 $0.00 $0.00 $137.87 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 80048 EAP CPT®80048 G-TUBE INSERTION BOTH IP/OP $26.00 $19.24 $0.00 $17.45 17.45 $17.45 $8.46 $8.46 4.23 4.23 12.85 $12.85 $13.35 $8.46 12.52 $5.50 $15.38 $15.38 $13.96 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 80053 EAP CPT®80053 #N/A BOTH IP/OP $32.00 $23.68 $0.00 $21.81 21.81 $21.81 $10.56 $10.56 5.28 5.28 16.06 $16.06 $16.68 $10.56 15.61 $6.86 $18.93 $18.93 $17.42 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 80061 EAP CPT®80061 SIGMOIDOSCOPY W/SUBMUC INJ BOTH IP/OP $41.00 $30.34 $0.00 $27.64 27.64 $27.64 $13.39 $13.39 6.7 6.7 20.35 $20.35 $21.14 $13.39 19.79 $8.70 $24.25 $24.25 $22.09 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 80069 EAP CPT®80069 #N/A BOTH IP/OP $27.00 $19.98 $0.00 $17.93 17.93 $17.93 $8.68 $8.68 4.34 4.34 13.19 $13.19 $13.69 $8.68 12.83 $5.64 $15.97 $15.97 $14.32 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 80076 EAP CPT®80076 ECC CERVICAL SCRAPE BOTH IP/OP $25.00 $18.50 $0.00 $16.87 16.87 $16.87 $8.17 $8.17 4.09 4.09 12.41 $12.41 $12.88 $8.17 12.08 $5.31 $14.79 $14.79 $13.48 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 81001 EAP CPT® 81001 FINGER 3 VIEWS BOTH IP/OP $10.00 $7.40 $0.00 $6.55 6.55 $6.55 $3.17 $3.17 1.59 1.58 4.82 $4.82 $5.00 $3.17 4.68 $2.06 $5.92 $5.92 $5.23 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 81003 EAP CPT®81003 US PELVIS LTD/FU NON-OB BOTH IP/OP $7.00 $5.18 $0.00 $4.65 4.65 $4.65 $2.25 $2.25 1.13 1.12 3.41 $3.41 $3.54 $2.25 3.33 $1.46 $4.14 $4.14 $3.71 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 81025 EAP CPT®81025 BASIC METABOLIC PANEL BOTH IP/OP $26.00 $19.24 $0.00 $15.38 13.04 $13.04 $8.61 $8.61 4.31 3.87 9.61 $9.61 $9.98 $8.61 9.36 $5.60 $15.38 $15.38 $14.21 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 82150 EAP CPT®82150 "RETICULOCYTES, AUTOMATED" BOTH IP/OP $20.00 $14.80 $0.00 $13.38 13.38 $13.38 $6.48 $6.48 3.24 3.24 9.84 $9.84 $10.22 $6.48 9.58 $4.21 $11.83 $11.83 $10.69 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 82274 EAP CPT® 82274 VFC FLU. VAC. 3-21 YRS BOTH IP/OP $48.00 $35.52 $0.00 $0.00 0 $0.00 $0.00 $0.00 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 82565 EAP CPT®82565 "NICU/PED/DEVELOP.TESTING,LIMI" BOTH IP/OP $16.00 $11.84 $0.00 $10.59 10.59 $10.59 $5.12 $5.12 2.56 2.56 7.78 $7.78 $8.08 $5.12 7.46 $3.33 $9.46 $9.46 $8.45 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 82947 EAP CPT®82947 "BLOOD,OCCULT,FECAL HGB,FECES,1-3 SIMULT" BOTH IP/OP $12.00 $8.88 $0.00 $44.80 $8.10 $8.10 $3.93 $3.93 $1.97 $0.00 $5.96 $5.96 $6.19 $0.00 $0.00 $0.00 $0.00 $0.00 $16.72 $44.44 $44.35 $44.80 $23.08 $0.00 $23.08 $27.15 $15.92 $15.92 $19.01 $15.92 $0.00 $0.00 $0.00 $0.00 82977 EAP CPT®82977 ASSAY OF IONIZED CALCIUM BOTH IP/OP $22.00 $16.28 $0.00 $14.86 14.86 $14.86 $7.20 $7.20 3.6 3.6 10.93 $10.93 $11.35 $7.20 7.46 $4.68 $13.01 $13.01 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 83036 EAP CPT®83036 ASSAY OF CK (CPK) BOTH IP/OP $30.00 $22.20 $0.00 $20.04 20.04 $20.04 $9.71 $9.71 4.86 4.86 14.74 $14.74 $15.30 $9.71 14.33 $6.31 $17.75 $17.75 $16.02 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 83540 EAP CPT®83540 CREATINE MB FRACTION BOTH IP/OP $20.00 $14.80 $0.00 $13.36 13.36 $13.36 $6.47 $6.47 3.24 3.24 9.84 $9.84 $10.22 $6.47 9.58 $4.21 $11.83 $11.83 $10.68 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 83615 EAP CPT®83615 ASSAY OF URINE CREATININE BOTH IP/OP $19.00 $14.06 $0.00 $12.46 12.46 $12.46 $6.04 $6.04 3.02 3.02 9.16 $9.16 $9.51 $6.04 7.46 $3.93 $11.24 $11.24 $9.97 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 83690 EAP CPT®83690 ASSAY OF FERRITIN BOTH IP/OP $21.00 $15.54 $0.00 $14.23 14.23 $14.23 $6.89 $6.89 3.45 3.44 10.46 $10.46 $10.86 $6.89 10.17 $4.48 $12.42 $12.42 $11.37 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 83721 EAP CPT®83721 ASSAY OF FOLIC ACID SERUM BOTH IP/OP $32.00 $23.68 $0.00 $19.69 19.69 $19.69 $10.50 $10.50 5.25 4.77 14.49 $14.49 $15.04 $10.50 14.1 $6.83 $18.93 $18.93 $17.33 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 83735 EAP CPT®83735 BLOOD PH BOTH IP/OP $21.00 $15.54 $0.00 $13.83 13.83 $13.83 $6.70 $6.70 3.35 3.35 10.17 $10.17 $10.56 $6.70 9.89 $4.36 $12.42 $12.42 $11.06 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 84100 EAP CPT®84100 ASSAY OF HAPTOGLOBIN QUANT BOTH IP/OP $15.00 $11.10 $0.00 $9.79 9.79 $9.79 $4.74 $4.74 2.37 2.37 7.21 $7.21 $7.48 $4.74 7.01 $3.08 $8.87 $8.87 $7.82 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 84132 EAP CPT®84132 HEMOGLOBIN ELECTROPHORESIS BOTH IP/OP $15.00 $11.10 $0.00 $9.50 9.5 $9.50 $4.76 $4.76 2.38 2.3 6.97 $6.97 $7.24 $4.76 6.79 $3.09 $8.87 $8.87 $7.85 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 84155 EAP CPT®84155 LACTATE (LD) (LDH) ENZYME BOTH IP/OP $12.00 $8.88 $0.00 $7.58 7.58 $7.58 $3.67 $3.67 1.84 0 5.56 $5.56 $5.78 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 84550 EAP CPT®84550 ASSAY OF SERUM POTASSIUM BOTH IP/OP $14.00 $10.36 $0.00 $9.32 9.32 $9.32 $4.52 $4.52 2.26 2.26 6.85 $6.85 $7.12 $4.52 6.67 $2.94 $8.28 $8.28 $7.46 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 85018 EAP CPT®85018 PROTEIN ELECTROPHORESIS SERUM BOTH IP/OP $8.00 $5.92 $0.00 $4.88 4.88 $4.88 $2.37 $2.37 1.19 1.18 3.6 $3.60 $3.74 $2.37 3.5 $1.54 $4.73 $4.73 $3.91 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 85025 EAP CPT®85025 ASSAY OF URINE SODIUM BOTH IP/OP $24.00 $17.76 $0.00 $16.05 16.05 $16.05 $7.77 $7.77 3.89 3.88 9.97 $9.97 $10.36 $7.77 11.48 $5.05 $14.20 $14.20 $12.82 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 85027 EAP CPT®85027 ASSAY OF FREE THYROXINE BOTH IP/OP $20.00 $14.80 $0.00 $13.36 13.36 $13.36 $6.47 $6.47 3.24 3.23 9.83 $9.83 $10.21 $6.47 9.57 $4.21 $11.83 $11.83 $10.68 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 85046 EAP CPT®85046 ASSAY THYROID STIM HORMONE BOTH IP/OP $17.00 $12.58 $0.00 $11.48 11.48 $11.48 $5.57 $5.57 2.79 2.79 8.48 $8.48 $8.80 $5.57 8.24 $3.62 $10.06 $10.06 $9.19 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 85610 EAP CPT®85610 ASSAY OF BLOOD/URIC ACID BOTH IP/OP $13.00 $9.62 $0.00 $0.00 0 $0.00 $0.00 $0.00 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 87070 EAP CPT® 87070 THROMBOPLASTIN TIME PARTIAL BOTH IP/OP $26.00 $19.24 $0.00 $0.00 0 $0.00 $0.00 $0.00 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 87210 EAP CPT®87210 VIRUS ANTIBODY NOS BOTH IP/OP $18.00 $13.32 $0.00 $10.65 8.82 $8.82 $5.82 $5.82 2.91 2.62 6.48 $6.48 $6.73 $5.82 6.3 $3.78 $10.65 $10.65 $9.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 87430 EAP CPT® 87430 Culture Other Specimen Aerobic BOTH IP/OP $51.00 $37.74 $0.00 $24.06 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.05 $24.06 $23.76 $24.00 $12.50 $0.00 $12.50 $13.56 $8.62 $8.62 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 90460 EAP CPT® 90460 TISSUE HOMOGENIZATION CULTURE BOTH IP/OP $47.00 $34.78 $0.00 $17.04 0 $0.00 $14.42 $14.42 17.04 0 16.28 $16.28 $16.90 $14.42 9.79 $9.37 $0.00 $0.00 $14.25 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 90461 EAP CPT® 90461 MICROBE SUSCEPTIBLE MIC BOTH IP/OP $36.00 $26.64 $0.00 $16.90 0 $0.00 $12.98 $12.98 12.86 0 16.28 $16.28 $16.90 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 90471 EAP CPT®90471 SMEAR GRAM STAIN BOTH IP/OP $47.00 $34.78 $0.00 $39.19 25.52 $25.52 $38.97 $38.97 39.19 9.8 34.88 $34.88 $36.23 $38.34 9.79 $24.92 $27.80 $27.80 $30.55 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 90472 EAP CPT®90472 SMEAR WET MOUNT SALINE/INK BOTH IP/OP $36.00 $26.64 $0.00 $27.75 19.55 $19.55 $0.00 $0.00 0 7.5 26.72 $26.72 $27.75 $0.00 7.5 $0.00 $21.29 $21.29 $23.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 90620 EAP CPT® 90620 CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE BOTH IP/OP $30.00 $22.20 $0.00 $171.96 13.5 $13.50 $0.00 $0.00 171.96 6.25 22.27 $22.27 $23.12 $0.00 30 $0.00 $17.75 $17.75 $13.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 90621 EAP CPT® 90621 IAAD IA STREPTOCOCCUS GROUP A BOTH IP/OP $30.00 $22.20 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $22.27 $22.27 $23.12 $0.00 $30.00 $0.00 $0.00 $0.00 $17.65 $33.52 $46.73 $47.20 $24.37 $13.50 $24.37 $18.87 $16.81 $16.81 $13.21 $16.81 $0.00 $0.00 $0.00 $0.00 90632 EAP CPT® 90632 "CHG CYTOPATH FLUIDS,SMEAR,INTERP" BOTH IP/OP $30.00 $22.20 $0.00 $56.67 13.5 $13.50 $0.00 $0.00 0 56.67 22.27 $22.27 $23.12 $0.00 30 $0.00 $17.75 $17.75 $13.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 90633 EAP CPT® 90633 "CHG CYTOPATH, CELL ENHANCE TECH" BOTH IP/OP $30.00 $22.20 $0.00 $23.12 13.5 $13.50 $0.00 $0.00 0 9.4 22.27 $22.27 $23.12 $0.00 6.25 $0.00 $17.75 $17.75 $13.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 90636 EAP CPT® 90636 CYTOPATH C/V THIN LAYER BOTH IP/OP $30.00 $22.20 $0.00 $13.50 0 $0.00 $0.00 $0.00 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $13.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 90647 EAP CPT® 90647 CYTOPATH FNA MISC BOTH IP/OP $30.00 $22.20 $0.00 $23.12 13.5 $13.50 $0.00 $0.00 0 0 22.27 $22.27 $23.12 $0.00 6.25 $0.00 $0.00 $0.00 $13.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 90648 EAP CPT® 90648 BODY FLUID CELL COUNT BOTH IP/OP $30.00 $22.20 $0.00 $23.12 13.5 $13.50 $0.00 $0.00 0 6.25 22.27 $22.27 $23.12 $0.00 6.25 $0.00 $17.75 $17.75 $13.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 90651 EAP CPT® 90651 IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX BOTH IP/OP $30.00 $22.20 $0.00 $229.60 $13.50 $13.50 $0.00 $0.00 $229.60 $6.25 $22.27 $22.27 $23.12 $0.00 $30.00 $0.00 $17.75 $17.75 $21.90 $10.97 $17.37 $17.54 $14.42 $13.50 $14.42 $7.83 $14.42 $14.42 $0.00 $14.42 $0.00 $0.00 $0.00 $0.00 90658 EAP CPT®90658 IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT BOTH IP/OP $30.00 $22.20 $0.00 $23.12 $13.50 $13.50 $0.00 $0.00 $15.36 $0.00 $22.27 $22.27 $23.12 $0.00 $0.00 $0.00 $0.00 $0.00 $13.61 $10.97 $17.37 $17.54 $12.98 $0.00 $12.98 $0.00 $12.98 $12.98 $0.00 $12.98 $0.00 $0.00 $0.00 $0.00 90670 EAP CPT® 90670 "PR IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID" BOTH IP/OP $30.00 $22.20 $0.00 $230.14 13.5 $13.50 $7.80 $7.80 230.14 6.25 22.27 $22.27 $23.12 $7.80 30 $5.07 $17.75 $17.75 $13.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 90674 EAP CPT® 90674 "IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID" BOTH IP/OP $30.00 $22.20 $5.07 $50.00 $13.50 $13.50 $7.80 $7.80 $29.23 $6.25 $22.27 $22.27 $23.12 $7.80 $30.00 $5.07 $17.75 $17.75 $38.22 $25.00 $39.60 $40.00 $50.00 $13.50 $50.00 $7.83 $14.42 $14.42 $7.96 $36.40 $0.00 $0.00 $0.00 $0.00 90680 EAP CPT® 90680 "PR IMMUNIZ,ADMIN,EACH ADDL" BOTH IP/OP $30.00 $22.20 $0.00 $23.12 13.5 $13.50 $0.00 $0.00 0 6.25 22.27 $22.27 $23.12 $0.00 6.25 $0.00 $17.75 $17.75 $13.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 90681 EAP CPT® 90681 "IMMUNIZ,ADMIN,EACH ADDL" BOTH IP/OP $30.00 $22.20 $0.00 $119.46 $13.50 $13.50 $0.00 $0.00 $119.46 $6.25 $22.27 $22.27 $23.12 $0.00 $6.25 $0.00 $17.75 $17.75 $0.00 $22.50 $35.64 $36.00 $0.00 $0.00 $0.00 $7.04 $12.98 $12.98 $7.16 $0.00 $0.00 $0.00 $0.00 $0.00 90685 EAP CPT® 90685 MENB RECOMBINANT PROT W/OUT MEMBR VESIC VACC IM BOTH IP/OP $30.00 $22.20 $0.00 $200.63 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $15.00 $23.76 $24.00 $18.00 $0.00 $18.00 $200.63 $0.00 $0.00 $191.04 $0.00 $0.00 $0.00 $0.00 $0.00 90686 EAP CPT® 90686 MENB RECOMBINANT LIPOPROTEIN VACCINE IM BOTH IP/OP $25.00 $18.50 $0.00 $163.94 $11.25 $11.25 $6.50 $6.50 $19.58 $5.21 $18.56 $18.56 $19.27 $6.50 $24.12 $4.23 $14.79 $14.79 $0.00 $15.00 $23.76 $24.00 $18.00 $11.25 $18.00 $163.94 $0.00 $0.00 $156.09 $0.00 $0.00 $0.00 $0.00 $0.00 90696 EAP CPT® 90696 HEPA VACCINE ADULT IM BOTH IP/OP $30.00 $22.20 $0.00 $70.39 $13.50 $13.50 $0.00 $0.00 $0.00 $6.25 $22.27 $22.27 $23.12 $0.00 $6.25 $0.00 $17.75 $17.75 $0.00 $15.00 $23.76 $24.00 $0.00 $13.50 $0.00 $70.39 $0.00 $0.00 $67.03 $0.00 $0.00 $0.00 $0.00 $0.00 90698 EAP CPT® 90698 HEPA VACCINE PED/ADOL-2 DOSE BOTH IP/OP $30.00 $22.20 $0.00 $24.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $22.27 $22.27 $23.12 $0.00 $6.25 $0.00 $0.00 $0.00 $0.00 $15.00 $23.76 $24.00 $0.00 $19.50 $0.00 $4.70 $0.00 $0.00 $4.78 $0.00 $0.00 $0.00 $0.00 $0.00 90700 EAP CPT® 90700 HEPA/HEPB VACCINE ADULT IM BOTH IP/OP $30.00 $22.20 $0.00 $122.20 $13.50 $13.50 $0.00 $0.00 $0.00 $6.25 $22.27 $22.27 $23.12 $0.00 $6.25 $0.00 $17.75 $17.75 $0.00 $15.00 $23.76 $24.00 $0.00 $13.50 $0.00 $122.20 $0.00 $0.00 $116.36 $0.00 $0.00 $0.00 $0.00 $0.00 90707 EAP CPT® 90707 "HIB VACCINE, PRP-OMP, IM" BOTH IP/OP $30.00 $22.20 $0.00 $30.00 $13.50 $13.50 $0.00 $0.00 $0.00 $11.75 $22.27 $22.27 $23.12 $0.00 $30.00 $0.00 $17.75 $17.75 $0.00 $15.00 $23.76 $24.00 $0.00 $13.50 $0.00 $4.70 $0.00 $0.00 $4.78 $0.00 $0.00 $0.00 $0.00 $0.00 90710 EAP CPT® 90710 "HIB VACCINE, PRP-T, IM" BOTH IP/OP $30.00 $22.20 $0.00 $24.00 $13.50 $13.50 $0.00 $0.00 $0.00 $6.25 $22.27 $22.27 $23.12 $0.00 $6.25 $0.00 $17.75 $17.75 $0.00 $15.00 $23.76 $24.00 $0.00 $13.50 $0.00 $4.70 $0.00 $0.00 $4.78 $0.00 $0.00 $0.00 $0.00 $0.00 90713 EAP CPT® 90713 HUMAN PAPILLOMA VIRUS NONAVALENT HPV 3 DOSE IM BOTH IP/OP $30.00 $22.20 $0.00 $267.82 $13.50 $13.50 $0.00 $0.00 $0.00 $9.40 $22.27 $22.27 $23.12 $0.00 $30.00 $0.00 $17.75 $17.75 $0.00 $15.00 $23.76 $24.00 $18.00 $13.50 $18.00 $267.82 $0.00 $0.00 $255.01 $0.00 $0.00 $0.00 $0.00 $0.00 90715 EAP CPT® 90715 PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM BOTH IP/OP $30.00 $22.20 $0.00 $252.18 $13.50 $13.50 $0.00 $0.00 $0.00 $6.25 $22.27 $22.27 $23.12 $0.00 $30.00 $0.00 $17.75 $17.75 $4.38 $15.00 $23.76 $24.00 $4.38 $13.50 $4.38 $252.18 $7.80 $7.80 $240.12 $7.80 $0.00 $0.00 $0.00 $0.00 90716 EAP CPT® 90716 CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE BOTH IP/OP $30.00 $22.20 $0.00 $136.66 $13.50 $13.50 $0.00 $0.00 $136.66 $9.40 $22.27 $22.27 $23.12 $0.00 $30.00 $0.00 $17.75 $17.75 $4.38 $15.00 $23.76 $24.00 $4.38 $13.50 $4.38 $33.05 $7.80 $7.80 $31.47 $7.80 $0.00 $0.00 $0.00 $0.00 90723 EAP CPT® 90723 "ROTOVIRUS VACCINE, ORAL" BOTH IP/OP $30.00 $22.20 $0.00 $79.00 $13.50 $13.50 $0.00 $0.00 $79.00 $6.25 $22.27 $22.27 $23.12 $0.00 $6.25 $0.00 $17.75 $17.75 $0.00 $15.00 $23.76 $24.00 $0.00 $13.50 $0.00 $4.70 $0.00 $0.00 $4.78 $0.00 $0.00 $0.00 $0.00 $0.00 90732 EAP CPT® 90732 "ROTOVIRUS VACCINE, HUMAN ATTENUATED, 2 DOSE, ORAL" BOTH IP/OP $30.00 $22.20 $0.00 $119.92 $13.50 $13.50 $7.80 $7.80 $119.92 $9.40 $22.27 $22.27 $23.12 $7.80 $30.00 $5.07 $17.75 $17.75 $0.00 $15.00 $23.76 $24.00 $18.00 $13.50 $18.00 $4.70 $0.00 $0.00 $4.78 $0.00 $0.00 $0.00 $0.00 $0.00 90734 EAP CPT® 90734 IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE BOTH IP/OP $30.00 $22.20 $0.00 $129.14 $13.50 $13.50 $0.00 $0.00 $129.14 $9.40 $22.27 $22.27 $23.12 $0.00 $30.00 $0.00 $17.75 $17.75 $0.00 $0.00 $23.76 $0.00 $0.00 $13.50 $0.00 $4.70 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 90744 EAP CPT® 90744 IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE BOTH IP/OP $30.00 $22.20 $0.00 $28.21 $13.50 $13.50 $7.80 $7.80 $28.21 $0.00 $22.27 $22.27 $23.12 $0.00 $0.00 $0.00 $0.00 $0.00 $3.65 $12.50 $19.80 $20.00 $3.65 $13.50 $3.65 $22.36 $6.50 $6.50 $21.29 $6.50 $0.00 $0.00 $0.00 $0.00 90746 EAP CPT® 90746 "DTAP-IPV, IM, AGE 4-6 YEAR" BOTH IP/OP $227.00 $167.98 $0.00 $174.97 $102.15 $102.15 $59.02 $59.02 $69.65 $70.16 $168.48 $168.48 $174.97 $59.02 $81.84 $38.36 $134.27 $134.27 $0.00 $15.00 $23.76 $24.00 $0.00 $102.15 $0.00 $4.70 $0.00 $0.00 $4.78 $0.00 $0.00 $0.00 $0.00 $0.00 90791 EAP CPT® 90791 "DTAP-HIB-IP VACCINE, IM" BOTH IP/OP $494.00 $365.56 $0.00 $380.78 $268.24 $268.24 $130.30 $130.30 $131.03 $102.96 $366.65 $366.65 $380.78 $128.07 $0.00 $83.25 $292.20 $292.20 $0.00 $15.00 $23.76 $24.00 $0.00 $321.10 $0.00 $4.70 $0.00 $0.00 $4.78 $0.00 $0.00 $0.00 $0.00 $0.00 90792 EAP CPT®90792 "DTAP IMMUNIZATION, IM" BOTH IP/OP $553.00 $409.22 $0.00 $426.25 $300.28 $300.28 $130.30 $130.30 $131.03 $115.26 $410.44 $410.44 $426.25 $128.07 $0.00 $83.25 $327.10 $327.10 $0.00 $15.00 $23.76 $24.00 $0.00 $359.45 $0.00 $4.70 $0.00 $0.00 $4.78 $0.00 $0.00 $0.00 $0.00 $0.00 90832 EAP CPT® 90832 "COMBINED VACCINE,MMR+VARICELLA,SQ" BOTH IP/OP $215.00 $159.10 $0.00 $165.72 $116.75 $116.75 $130.30 $130.30 $131.03 $44.81 $159.57 $159.57 $165.72 $128.07 $0.00 $83.25 $127.17 $127.17 $0.00 $15.00 $23.76 $24.00 $0.00 $139.75 $0.00 $4.70 $0.00 $0.00 $4.78 $0.00 $0.00 $0.00 $0.00 $0.00 90832 EAP CPT®90832 "MMR VIRUS IMMUNIZATION, SUBCUT" BOTH IP/OP $215.00 $159.10 $0.00 $165.72 $116.75 $116.75 $130.30 $130.30 $131.03 $44.81 $159.57 $159.57 $165.72 $128.07 $0.00 $83.25 $127.17 $127.17 $0.00 $15.00 $23.76 $24.00 $0.00 $139.75 $0.00 $92.45 $0.00 $0.00 $88.03 $0.00 $0.00 $0.00 $0.00 $0.00 90834 EAP CPT®90834 "POLIOMYELITIS IMMUNIZATN,INACTV,SQ" BOTH IP/OP $284.00 $210.16 $0.00 $218.91 $154.21 $154.21 $130.30 $130.30 $131.03 $59.19 $210.78 $210.78 $218.91 $128.07 $0.00 $83.25 $167.99 $167.99 $0.00 $15.00 $23.76 $24.00 $0.00 $184.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 90837 EAP CPT®90837 TDAP VACCINE >7 IM BOTH IP/OP $417.00 $308.58 $0.00 $321.42 $226.43 $226.43 $130.30 $130.30 $131.03 $86.91 $309.50 $309.50 $321.42 $128.07 $0.00 $83.25 $246.66 $246.66 $0.00 $15.00 $23.76 $24.00 $0.00 $271.05 $0.00 $39.53 $0.00 $0.00 $37.64 $0.00 $0.00 $0.00 $0.00 $0.00 91111 EAP CPT® 91111 "HEP B VACCINE,PED/ADOL,IM" BOTH IP/OP "$2,479.00 " "$1,834.46" $0.00 "$2,479.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $15.00 $23.76 $24.00 $18.00 "$2,479.00" $18.00 $4.70 $7.80 $7.80 $0.00 $7.80 $0.00 $0.00 $0.00 $0.00 92250 EAP CPT®92250 PR PSYCHOTHERAPY W/PATIENT 45 MINUTES BOTH IP/OP $105.00 $77.70 $0.00 $109.81 57.02 $57.02 $109.81 $109.81 105 21.88 77.93 $77.93 $80.93 $107.30 21.88 $69.74 $62.11 $62.11 $68.25 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 92551 EAP CPT® 92551 PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS BOTH IP/OP $40.00 $29.60 $0.00 $30.83 21.72 $21.72 $0.00 $0.00 11.81 8.34 29.69 $29.69 $30.83 $0.00 8.34 $0.00 $23.66 $23.66 $26.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 92552 EAP CPT® 92552 PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS BOTH IP/OP $95.00 $70.30 $0.00 $0.00 0 $0.00 $0.00 $0.00 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 93000 EAP CPT® 93000 "PR EYE EXAM, EST PATIENT,COMPREHESV" BOTH IP/OP $40.00 $29.60 $0.00 $37.57 37.57 $37.57 $17.30 $17.30 14.92 0 29.69 $29.69 $30.83 $17.30 8.34 $11.25 $0.00 $0.00 $26.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 93015 EAP CPT® 93015 PR COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE BOTH IP/OP $200.00 $148.00 $0.00 $169.04 169.04 $169.04 $72.09 $72.09 71.62 0 148.44 $148.44 $154.16 $72.09 41.68 $46.86 $0.00 $0.00 $130.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 93225 EAP CPT®93225 PR FUNDAL PHOTOGRAPHY BOTH IP/OP $59.00 $43.66 $0.00 $109.81 58.71 $58.71 $109.81 $109.81 59 12.3 43.79 $43.79 $45.48 $107.30 12.3 $69.74 $34.90 $34.90 $38.35 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 93227 EAP CPT®93227 FUNDAL PHOTOGRAPHY BOTH IP/OP $56.00 $41.44 $0.00 $151.93 $56.00 $56.00 $27.05 $27.05 $18.80 $0.00 $0.00 $0.00 $0.00 $0.00 $11.67 $0.00 $0.00 $0.00 $109.35 $80.00 $126.72 $128.00 $151.93 $36.40 $151.93 $59.03 $23.77 $23.77 $25.47 $104.14 $0.00 $0.00 $0.00 $0.00 93242 EAP CPT®93242 PR SPEECH/HEARING THERAPY BOTH IP/OP $43.00 $31.82 $0.00 $33.14 0 $0.00 $0.00 $0.00 0 0 31.91 $31.91 $33.14 $0.00 8.96 $0.00 $0.00 $0.00 $27.95 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 93244 EAP CPT®93244 "PURE TONE HEARING TEST, AIR" BOTH IP/OP $73.00 $54.02 $0.00 $47.45 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $15.21 $0.00 $0.00 $0.00 $0.00 $22.00 $34.85 $35.20 $26.40 $47.45 $26.40 $9.01 $0.00 $0.00 $7.00 $0.00 $0.00 $0.00 $0.00 $0.00 93246 EAP CPT®93246 "PURE TONE AUDIOMETRY, AIR" BOTH IP/OP $43.00 $31.82 $0.00 $112.00 $0.00 $0.00 $54.21 $54.21 $0.00 $0.00 $31.91 $31.91 $33.14 $0.00 $8.96 $0.00 $0.00 $0.00 $109.35 $56.00 $88.70 $89.60 $112.00 $27.95 $112.00 $17.48 $32.05 $32.05 $17.83 $104.14 $0.00 $0.00 $0.00 $0.00 93248 EAP CPT®93248 PR TYMPANOMETRY BOTH IP/OP $81.00 $59.94 $0.00 $52.65 0 $0.00 $0.00 $0.00 0 0 $0.00 $0.00 $0.00 $0.00 16.88 $0.00 $0.00 $0.00 $52.65 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 93306 EAP CPT®93306 "PR AUDITORY EVOKED POTENTIAL, LIMITED" BOTH IP/OP $566.00 $418.84 $0.00 $504.77 504.77 $504.77 $470.55 $470.55 473.2 117.97 420.09 $420.09 $436.27 $462.81 117.95 $300.83 $334.79 $334.79 $367.90 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 93880 EAP CPT® 93880 CV STRS TST XERS&/OR RX CONT ECG W/SI&R BOTH IP/OP $116.00 $85.84 $0.00 $562.53 $116.00 $116.00 $224.08 $224.08 $116.00 $24.18 $541.69 $541.69 $562.53 $220.56 $24.17 $143.36 $68.61 $68.61 $76.29 $126.00 $199.58 $201.60 $72.09 $75.40 $72.09 $110.83 $72.09 $72.09 $0.00 $72.09 $0.00 $0.00 $0.00 $0.00 93926 EAP CPT® 93926 "PR CARDIAC STRESS TST,TRACING ONLY" BOTH IP/OP $381.00 $281.94 $0.00 $0.00 0 $0.00 $0.00 $0.00 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 93970 EAP CPT®93970 "PR ECHO HEART XTHORACIC,COMPLETE W DOPPLER" BOTH IP/OP $102.00 $75.48 $0.00 $565.47 102 $102.00 $224.08 $224.08 102 21.26 544.52 $544.52 $565.47 $220.56 21.26 $143.36 $60.33 $60.33 $66.30 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 93971 EAP CPT®93971 "PR ECHO HEART XTHORACIC,LIMITED" BOTH IP/OP $343.00 $253.82 $0.00 $374.41 266.11 $266.11 $106.02 $106.02 106.62 71.49 360.55 $360.55 $374.41 $104.44 71.48 $67.89 $202.88 $202.88 $222.95 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 94640 EAP CPT® 94640 DUPLEX LO EXTREM ART UNILAT/LTD BOTH IP/OP $32.00 $23.68 $0.00 $383.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $112.41 $239.50 $379.37 $383.20 $156.18 $0.00 $156.18 $120.13 $127.86 $127.86 $76.26 $107.06 $0.00 $0.00 $0.00 $0.00 94664 EAP CPT®94664 "DUPLEX EXTREM VENOUS,BILAT" BOTH IP/OP $48.00 $35.52 $0.00 $556.00 $26.06 $26.06 $183.05 $183.05 $48.00 $10.00 $35.63 $35.63 $37.00 $180.07 $10.00 $117.04 $28.39 $28.39 $233.72 $347.50 $550.44 $556.00 $324.73 $0.00 $324.73 $199.35 $163.16 $163.16 $110.64 $222.60 $0.00 $0.00 $0.00 $0.00 96110 EAP CPT®96110 "PR POS AIRWAY PRESSURE, CPAP" BOTH IP/OP $35.00 $25.90 $0.00 $26.98 0 $0.00 $0.00 $0.00 10.07 0 25.98 $25.98 $26.98 $0.00 7.29 $0.00 $0.00 $0.00 $22.75 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 96127 EAP CPT®96127 "PR EXHALED AIR ANALYSIS: O2, CO2" BOTH IP/OP $14.00 $10.36 $0.00 $32.96 0 $0.00 $32.96 $32.96 14 0 $0.00 $0.00 $0.00 $32.43 $0.00 $21.08 $0.00 $0.00 $9.10 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 96161 EAP CPT® 96161 PR PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST BOTH IP/OP $8.00 $5.92 $0.00 $25.59 0 $0.00 $25.59 $25.59 8 0 5.94 $5.94 $6.17 $25.14 1.67 $16.34 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 96361 EAP CPT® 96361 PR DIFFUSING CAPACITY BOTH IP/OP $37.00 $27.38 $0.00 $38.34 0 $0.00 $0.00 $0.00 0 7.71 $0.00 $0.00 $0.00 $38.34 7.71 $24.92 $21.89 $21.89 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 96372 EAP CPT® 96372 PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND BOTH IP/OP $41.00 $30.34 $0.00 $60.38 22.26 $22.26 $60.38 $60.38 41 8.55 30.43 $30.43 $31.60 $59.39 $0.00 $38.61 $24.25 $24.25 $26.65 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 97802 EAP CPT® 97802 PR DEBRIDEMENT OPEN WOUND 20 SQ CM< BOTH IP/OP $104.00 $76.96 $0.00 $80.16 56.47 $56.47 $34.61 $34.61 33.05 21.68 77.19 $77.19 $80.16 $34.61 21.67 $22.50 $61.52 $61.52 $67.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 97803 EAP CPT® 97803 "PR ORTHOTIC MGMT AND TRAINING, EACH 15 MIN" BOTH IP/OP $90.00 $66.60 $0.00 $69.37 48.87 $48.87 $29.21 $29.21 28.17 18.76 66.8 $66.80 $69.37 $29.21 18.76 $18.99 $53.24 $53.24 $58.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 98966 EAP CPT® 98966 PR ORTHOTICS/PROSTH MGMT &/TRAINJ SBSQ ENCTR 15 MIN BOTH IP/OP $37.00 $27.38 $0.00 $24.05 0 $0.00 $0.00 $0.00 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $24.05 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 98967 EAP CPT® 98967 "MED NUTR THER, 1ST, INDIV, EA 15 MIN" BOTH IP/OP $67.00 $49.58 $0.00 $107.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $29.55 $67.00 $106.13 $107.20 $34.61 $43.55 $34.61 $20.97 $34.61 $34.61 $21.33 $34.61 $0.00 $0.00 $0.00 $0.00 98968 EAP CPT® 98968 "MED NUTR THER, SUBSQ, INDIV, EA 15 MIN" BOTH IP/OP $95.00 $70.30 $0.00 $92.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $25.06 $58.00 $91.87 $92.80 $29.21 $61.75 $29.21 $18.15 $29.21 $29.21 $18.47 $29.21 $0.00 $0.00 $0.00 $0.00 99024 EAP CPT® 99024 NONPHYSICIAN TELEPHONE ASSESSMENT 5-10 MIN BOTH IP/OP $0.01 $0.01 $0.00 $128.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $80.50 $127.51 $128.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 99173 EAP CPT® 99173 NONPHYSICIAN TELEPHONE ASSESSMENT 11-20 MIN BOTH IP/OP $11.00 $8.14 $0.00 $212.80 $0.00 $0.00 $0.00 $0.00 $3.10 $0.00 $8.16 $8.16 $8.48 $0.00 $2.29 $0.00 $0.00 $0.00 $0.00 $133.00 $210.67 $212.80 $159.60 $7.15 $159.60 $41.63 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 99202 EAP CPT® 99202 "VISUAL SCREENING TEST, BILAT" BOTH IP/OP $204.00 $150.96 $0.00 $323.29 $0.00 $0.00 $51.57 $51.57 $49.57 $67.13 $311.31 $311.31 $323.29 $51.57 $0.00 $33.52 $120.67 $120.67 $0.00 $5.50 $8.71 $8.80 $6.60 $204.00 $6.60 $1.72 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 99202 EAP CPT®99202 POST-OP FOLLOW-UP VISIT BOTH IP/OP $204.00 $150.96 $0.00 $323.29 $0.00 $0.00 $51.57 $51.57 $49.57 $67.13 $311.31 $311.31 $323.29 $51.57 $0.00 $33.52 $120.67 $120.67 $0.00 $0.00 $0.01 $0.00 $0.00 $204.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 99203 EAP CPT®99203 OFFICE OUTPATIENT NEW 10 MINUTES BOTH IP/OP $314.00 $232.36 $0.00 $323.29 $0.00 $0.00 $77.17 $77.17 $83.89 $67.13 $311.31 $311.31 $323.29 $77.17 $0.00 $50.16 $185.73 $185.73 $28.83 $164.50 $260.57 $263.20 $27.04 $314.00 $27.04 $108.52 $27.04 $27.04 $99.16 $27.04 $0.00 $0.00 $0.00 $0.00 99204 EAP CPT®99204 OFFICE OUTPATIENT NEW 20 MINUTES BOTH IP/OP $467.00 $345.58 $0.00 $467.00 $0.00 $0.00 $131.98 $131.98 $136.63 $67.13 $311.31 $311.31 $323.29 $131.98 $0.00 $85.79 $276.23 $276.23 $54.20 $189.00 $299.38 $302.40 $51.57 $467.00 $51.57 $108.52 $51.57 $51.57 $99.16 $51.57 $0.00 $0.00 $0.00 $0.00 99205 EAP CPT®99205 OFFICE OUTPATIENT NEW 30 MINUTES BOTH IP/OP $618.00 $457.32 $0.00 $618.00 $0.00 $0.00 $172.37 $172.37 $185.53 $67.13 $311.31 $311.31 $323.29 $172.37 $0.00 $112.04 $365.55 $365.55 $82.35 $221.00 $350.06 $353.60 $77.17 $618.00 $77.17 $108.52 $77.17 $77.17 $99.16 $77.17 $0.00 $0.00 $0.00 $0.00 99211 EAP CPT®99211 OFFICE OUTPATIENT NEW 45 MINUTES BOTH IP/OP $65.00 $48.10 $0.00 $455.20 $0.00 $0.00 $9.38 $9.38 $9.03 $67.13 $311.31 $311.31 $323.29 $9.38 $0.00 $6.10 $38.45 $38.45 $138.78 $284.50 $450.65 $455.20 $131.98 $65.00 $131.98 $108.52 $131.98 $131.98 $99.16 $131.98 $0.00 $0.00 $0.00 $0.00 99212 EAP CPT®99212 OFFICE OUTPATIENT NEW 60 MINUTES BOTH IP/OP $159.00 $117.66 $0.00 $548.80 $0.00 $0.00 $26.32 $26.32 $36.10 $67.13 $311.31 $311.31 $323.29 $26.32 $0.00 $17.11 $94.05 $94.05 $181.26 $343.00 $543.31 $548.80 $172.37 $159.00 $172.37 $108.52 $172.37 $172.37 $99.16 $172.37 $0.00 $0.00 $0.00 $0.00 99213 EAP CPT®99213 OFFICE OUTPATIENT VISIT 5 MINUTES BOTH IP/OP $254.00 $187.96 $0.00 $323.29 $0.00 $0.00 $52.29 $52.29 $67.67 $67.13 $311.31 $311.31 $323.29 $52.29 $0.00 $33.99 $150.24 $150.24 $9.84 $145.00 $229.68 $232.00 $9.38 $254.00 $9.38 $108.52 $9.38 $9.38 $99.16 $9.38 $0.00 $0.00 $0.00 $0.00 99214 EAP CPT®99214 OFFICE OUTPATIENT VISIT 10 MINUTES BOTH IP/OP $358.00 $264.92 $0.00 $358.00 $0.00 $0.00 $80.42 $80.42 $99.97 $67.13 $311.31 $311.31 $323.29 $80.42 $0.00 $52.27 $211.76 $211.76 $27.29 $156.50 $247.90 $250.40 $26.32 $358.00 $26.32 $108.52 $26.32 $26.32 $99.16 $26.32 $0.00 $0.00 $0.00 $0.00 99215 EAP CPT®99215 OFFICE OUTPATIENT VISIT 15 MINUTES BOTH IP/OP $505.00 $373.70 $0.00 $505.00 $0.00 $0.00 $113.60 $113.60 $147.16 $67.13 $311.31 $311.31 $323.29 $113.60 $0.00 $73.84 $298.71 $298.71 $54.93 $199.50 $316.01 $319.20 $52.29 $505.00 $52.29 $108.52 $52.29 $52.29 $99.16 $52.29 $0.00 $0.00 $0.00 $0.00 99242 EAP CPT®99242 OFFICE OUTPATIENT VISIT 25 MINUTES BOTH IP/OP $288.00 $213.12 $0.00 $392.80 $0.00 $0.00 $0.00 $0.00 $67.99 $0.00 $311.31 $311.31 $323.29 $0.00 $60.02 $0.00 $0.00 $0.00 $84.06 $245.50 $388.87 $392.80 $80.42 $187.20 $80.42 $108.52 $80.42 $80.42 $99.16 $80.42 $0.00 $0.00 $0.00 $0.00 99243 EAP CPT®99243 PR OFFICE OUTPATIENT VISIT 40 MINUTES BOTH IP/OP $436.00 $322.64 $0.00 $0.00 0 $0.00 $0.00 $0.00 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 99244 EAP CPT® 99244 OFFICE CONSULTATION NEW/ESTAB PATIENT 40 MIN BOTH IP/OP $652.00 $482.48 $0.00 $423.80 $0.00 $0.00 $0.00 $0.00 $152.96 $0.00 $311.31 $311.31 $323.29 $0.00 $135.88 $0.00 $0.00 $0.00 $0.00 $218.00 $345.31 $348.80 $261.60 $423.80 $261.60 $112.44 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 99381 EAP CPT® 99381 PR OFFICE CONSULTATION NEW/ESTAB PATIENT 60 MIN BOTH IP/OP $395.00 $292.30 $0.00 $323.29 0 $0.00 $0.00 $0.00 76.64 0 311.31 $311.31 $323.29 $0.00 82.32 $0.00 $0.00 $0.00 $256.75 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 99382 EAP CPT® 99382 OFFICE CONSULTATION NEW/ESTAB PATIENT 60 MIN BOTH IP/OP $413.00 $305.62 $0.00 $521.60 $0.00 $0.00 $0.00 $0.00 $81.52 $0.00 $311.31 $311.31 $323.29 $0.00 $86.07 $0.00 $0.00 $0.00 $0.00 $326.00 $516.38 $521.60 $391.20 $268.45 $391.20 $155.65 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 99383 EAP CPT® 99383 "PREVENTIVE VISIT,NEW,INFANT < 1 YR" BOTH IP/OP $429.00 $317.46 $0.00 $323.29 $0.00 $0.00 $0.00 $0.00 $86.72 $0.00 $311.31 $311.31 $323.29 $0.00 $89.40 $0.00 $0.00 $0.00 $0.00 $197.50 $312.84 $316.00 $237.00 $278.85 $237.00 $61.82 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 99384 EAP CPT® 99384 "PREVENTIVE VISIT,NEW,AGE 1-4" BOTH IP/OP $485.00 $358.90 $0.00 $330.40 $0.00 $0.00 $0.00 $0.00 $101.65 $0.00 $311.31 $311.31 $323.29 $0.00 $101.07 $0.00 $0.00 $0.00 $0.00 $206.50 $327.10 $330.40 $247.80 $315.25 $247.80 $64.63 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 99385 EAP CPT®99385 "PREVENTIVE VISIT,NEW,AGE5-11" BOTH IP/OP $469.00 $347.06 $0.00 $343.20 $0.00 $0.00 $0.00 $0.00 $97.50 $0.00 $311.31 $311.31 $323.29 $0.00 $97.74 $0.00 $0.00 $0.00 $0.00 $214.50 $339.77 $343.20 $257.40 $304.85 $257.40 $67.14 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 99386 EAP CPT®99386 "PR PREVENTIVE VISIT,NEW,18-39" BOTH IP/OP $545.00 $403.30 $0.00 $354.25 0 $0.00 $0.00 $0.00 118.64 0 311.31 $311.31 $323.29 $0.00 113.58 $0.00 $0.00 $0.00 $354.25 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 99387 EAP CPT® 99387 "PR PREVENTIVE VISIT,NEW,40-64" BOTH IP/OP $591.00 $437.34 $0.00 $123.16 0 $0.00 $0.00 $0.00 0 0 $0.00 $0.00 $0.00 $0.00 123.16 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 99391 EAP CPT® 99391 "PREVENTIVE VISIT,NEW,40-64" BOTH IP/OP $354.00 $261.96 $0.00 $436.00 $0.00 $0.00 $0.00 $0.00 $69.73 $0.00 $311.31 $311.31 $323.29 $0.00 $73.77 $0.00 $0.00 $0.00 $0.00 $272.50 $431.64 $436.00 $327.00 $230.10 $327.00 $84.34 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 99392 EAP CPT® 99392 "PREVENTIVE VISIT,NEW,65 & OVER" BOTH IP/OP $378.00 $279.72 $0.00 $472.80 $0.00 $0.00 $0.00 $0.00 $76.64 $0.00 $311.31 $311.31 $323.29 $0.00 $78.78 $0.00 $0.00 $0.00 $0.00 $295.50 $468.07 $472.80 $0.00 $245.70 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 99393 EAP CPT® 99393 "PREVENTIVE VISIT,EST, INFANT < 1 YR" BOTH IP/OP $377.00 $278.98 $0.00 $323.29 $0.00 $0.00 $0.00 $0.00 $76.64 $0.00 $311.31 $311.31 $323.29 $0.00 $78.57 $0.00 $0.00 $0.00 $0.00 $177.00 $280.37 $283.20 $212.40 $245.05 $212.40 $55.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 99394 EAP CPT® 99394 "PREVENTIVE VISIT,EST,AGE 1-4" BOTH IP/OP $414.00 $306.36 $0.00 $323.29 $0.00 $0.00 $0.00 $0.00 $86.72 $0.00 $311.31 $311.31 $323.29 $0.00 $86.28 $0.00 $0.00 $0.00 $0.00 $189.00 $299.38 $302.40 $226.80 $269.10 $226.80 $59.16 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 99395 EAP CPT® 99395 "PREVENTIVE VISIT,EST,AGE5-11" BOTH IP/OP $423.00 $313.02 $0.00 $323.29 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $311.31 $311.31 $323.29 $0.00 $88.15 $0.00 $0.00 $0.00 $0.00 $188.50 $298.58 $301.60 $226.20 $274.95 $226.20 $59.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 99396 EAP CPT® 99396 "PREVENTIVE VISIT,EST,12-17" BOTH IP/OP $450.00 $333.00 $0.00 $331.20 $0.00 $0.00 $0.00 $0.00 $96.80 $0.00 $311.31 $311.31 $323.29 $0.00 $93.78 $0.00 $0.00 $0.00 $0.00 $207.00 $327.89 $331.20 $248.40 $292.50 $248.40 $64.79 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 99397 EAP CPT®99397 "PREVENTIVE VISIT,EST,18-39" BOTH IP/OP $486.00 $359.64 $0.00 $338.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $311.31 $311.31 $323.29 $0.00 $101.28 $0.00 $0.00 $0.00 $0.00 $211.50 $335.02 $338.40 $253.80 $315.90 $253.80 $84.34 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 99406 EAP CPT® 99406 "PREVENTIVE VISIT,EST,40-64" BOTH IP/OP $43.00 $31.82 $0.00 $360.00 $0.00 $0.00 $25.59 $25.59 $0.00 $0.00 $311.31 $311.31 $323.29 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $225.00 $356.40 $360.00 $270.00 $27.95 $270.00 $84.34 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 99441 EAP CPT® 99441 TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES BOTH IP/OP $157.00 $116.18 $0.00 $102.05 $0.00 $0.00 $0.00 $0.00 $36.10 $0.00 $0.00 $0.00 $0.00 $0.00 $32.72 $0.00 $0.00 $0.00 $0.00 $27.00 $42.77 $43.20 $0.00 $102.05 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 99442 EAP CPT® 99442 PHYS/QHP TELEPHONE EVALUATION 5-10 MIN BOTH IP/OP $253.00 $187.22 $0.00 $164.45 $0.00 $0.00 $0.00 $0.00 $67.98 $0.00 $0.00 $0.00 $0.00 $0.00 $52.73 $0.00 $0.00 $0.00 $0.00 $80.50 $127.51 $128.80 $96.60 $164.45 $96.60 $25.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 99443 EAP CPT® 99443 PHYS/QHP TELEPHONE EVALUATION 11-20 MIN BOTH IP/OP $358.00 $264.92 $0.00 $232.70 $0.00 $0.00 $0.00 $0.00 $100.28 $0.00 $0.00 $0.00 $0.00 $0.00 $74.61 $0.00 $0.00 $0.00 $0.00 $133.00 $210.67 $212.80 $159.60 $232.70 $159.60 $41.63 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 99495 EAP CPT® 99495 PHYS/QHP TELEPHONE EVALUATION 21-30 MIN BOTH IP/OP $576.00 $426.24 $0.00 $576.00 $0.00 $0.00 $115.71 $115.71 $116.36 $67.13 $311.31 $311.31 $323.29 $113.80 $120.04 $73.97 $340.70 $340.70 $0.00 $193.00 $305.71 $308.80 $231.60 $576.00 $231.60 $60.41 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 99496 EAP CPT® 99496 TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE BOTH IP/OP $777.00 $574.98 $0.00 $777.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $116.27 $328.00 $519.55 $524.80 $161.54 $777.00 $161.54 $102.66 $125.50 $125.50 $104.44 $110.73 $0.00 $0.00 $0.00 $0.00 99497 EAP CPT®99497 TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE BOTH IP/OP $236.00 $174.64 $0.00 $693.60 $0.00 $0.00 $72.87 $72.87 $73.28 $67.13 $311.31 $311.31 $323.29 $71.76 $49.18 $46.64 $139.59 $139.59 $116.27 $433.50 $686.66 $693.60 $161.54 $236.00 $161.54 $135.69 $165.53 $165.53 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 10932085 EAP HCPCS C1729 Catheter Urethral 8fr Foley 2 Way Latex Dover Silicone BOTH IP/OP $107.00 $79.18 $0.00 $85.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $53.50 $84.74 $85.60 $0.00 $0.00 $0.00 $16.75 $0.00 $0.00 $17.03 $0.00 $0.00 $0.00 $0.00 $0.00 10933190 EAP HCPCS C1729 Catheter Urethral 18fr Foley 2 Way Medium Olive Coude Tip 1 BOTH IP/OP $26.00 $19.24 $0.00 $20.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $13.00 $20.59 $20.80 $0.00 $0.00 $0.00 $4.07 $0.00 $0.00 $4.14 $0.00 $0.00 $0.00 $0.00 $0.00 10945160 EAP HCPCS C1751 Catheter Umb 3.5fr 15in .15ml Clr Strl Lf Arg 1 Lum Ll Hub BOTH IP/OP $34.00 $25.16 $0.00 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $17.00 $26.93 $27.20 $0.00 $0.00 $0.00 $5.32 $0.00 $0.00 $5.41 $0.00 $0.00 $0.00 $0.00 $0.00 10945178 EAP HCPCS C1751 Cap Tube 13mm Blu Eztpr Dbl Flng Sl Thb Tab Pe BOTH IP/OP $34.00 $25.16 $0.00 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $17.00 $26.93 $27.20 $0.00 $0.00 $0.00 $5.32 $0.00 $0.00 $5.41 $0.00 $0.00 $0.00 $0.00 $0.00 10945194 EAP HCPCS C1729 System Drn 35cm 700ml Blu Strl Lf Be2 Mntr Trndcr Atch Vntrc BOTH IP/OP $742.00 $549.08 $0.00 "$1,045.60" $402.91 $402.91 $0.00 $0.00 $0.00 $154.65 $550.71 $550.71 $571.93 $0.00 $154.63 $0.00 $438.89 $438.89 $0.00 $653.50 "$1,035.14" "$1,045.60" $0.00 $482.30 $0.00 $204.55 $0.00 $0.00 $208.07 $0.00 $0.00 $0.00 $0.00 $0.00 10961170 EAP HCPCS C1751 Kit Arterial Line .018in 20ga 22ga 1.75in Catheter Radiopq BOTH IP/OP $38.00 $28.12 $0.00 $45.60 $20.63 $20.63 $0.00 $0.00 $0.00 $7.92 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $22.48 $22.48 $0.00 $28.50 $45.14 $45.60 $0.00 $24.70 $0.00 $8.92 $0.00 $0.00 $9.07 $0.00 $0.00 $0.00 $0.00 $0.00 11100001 EAP Custom 11100001 HB MED-SUR-GY/PVT BOTH IP/OP "$3,058.00 " "$2,262.92" $0.00 "$2,135.23" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,135.23" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 11100003 EAP Custom 11100003 Tele Private Med Surg BOTH IP/OP "$3,378.00 " "$2,499.72" $0.00 "$2,358.58" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,358.58" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 11100021 EAP Custom 11100021 HB PVT GYN BOTH IP/OP "$3,058.00 " "$2,262.92" $0.00 "$2,135.23" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,135.23" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 11100023 EAP Custom 11100023 Tele Private Gyn BOTH IP/OP "$3,378.00 " "$2,499.72" $0.00 "$2,358.58" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,358.58" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 11100501 EAP Custom 11100501 Trauma Private Med Surg BOTH IP/OP "$3,398.00 " "$2,514.52" $0.00 "$2,372.83" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,372.83" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 11100503 EAP Custom 11100503 Trauma Tele Private Med Surg BOTH IP/OP "$3,718.00 " "$2,751.32" $0.00 "$2,596.18" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,596.18" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 11100521 EAP Custom 11100521 Trauma Private Gyn BOTH IP/OP "$3,398.00 " "$2,514.52" $0.00 "$2,372.83" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,372.83" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 11100523 EAP Custom 11100523 Trauma Tele Private Gyn BOTH IP/OP "$3,718.00 " "$2,751.32" $0.00 "$2,596.18" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,596.18" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 11200001 EAP Custom 11200001 Private Ob BOTH IP/OP "$3,218.00 " "$2,381.32" $0.00 "$2,247.70" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,247.70" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 11200002 EAP Custom 11200002 Tele Private Ob BOTH IP/OP "$3,533.00 " "$2,614.42" $0.00 "$2,467.08" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,467.08" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 11200501 EAP Custom 11200501 Trauma Private Ob BOTH IP/OP "$3,559.00 " "$2,633.66" $0.00 "$2,485.30" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,485.30" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 11200502 EAP Custom 11200502 Trauma Tele Private Ob BOTH IP/OP "$3,873.00 " "$2,866.02" $0.00 "$2,704.68" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,704.68" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 11400002 EAP Custom 11400002 Private Psy BOTH IP/OP "$2,837.00 " "$2,099.38" $0.00 "$1,980.79" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,980.79" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 11400502 EAP Custom 11400502 Trauma Private Psy BOTH IP/OP "$3,177.00 " "$2,350.98" $0.00 "$2,218.39" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,218.39" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 11500001 EAP Custom 11500001 Inpatient Hospice BOTH IP/OP "$3,065.00 " "$2,268.10" $0.00 "$2,139.98" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,139.98" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 11500501 EAP Custom 11500501 TRAUMA INPATIENT HOSPICE BOTH IP/OP "$3,176.00 " "$2,350.24" $0.00 "$2,217.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,217.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 12100001 EAP Custom 12100001 Semiprivate Medsurg BOTH IP/OP "$2,166.00 " "$1,602.84" $0.00 "$1,512.72" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,512.72" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 12100003 EAP Custom 12100003 Tele Semiprivate BOTH IP/OP "$2,550.00 " "$1,887.00" $0.00 "$1,780.42" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,780.42" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 12100021 EAP Custom 12100021 Semiprivate Gyn BOTH IP/OP "$2,166.00 " "$1,602.84" $0.00 "$1,512.72" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,512.72" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 12100023 EAP Custom 12100023 Tele Semiprivate Gyn BOTH IP/OP "$2,550.00 " "$1,887.00" $0.00 "$1,780.42" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,780.42" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 12100501 EAP Custom 12100501 Trauma Semiprivate Medsurg BOTH IP/OP "$2,507.00 " "$1,855.18" $0.00 "$1,750.32" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,750.32" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 12100503 EAP Custom 12100503 Trauma Tele Semiprivate BOTH IP/OP "$2,890.00 " "$2,138.60" $0.00 "$2,018.02" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,018.02" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 12100521 EAP Custom 12100521 Trauma Semiprivate Gyn BOTH IP/OP "$2,507.00 " "$1,855.18" $0.00 "$1,750.32" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,750.32" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 12100523 EAP Custom 12100523 Trauma Tele Semiprivate Gyn BOTH IP/OP "$2,890.00 " "$2,138.60" $0.00 "$2,018.02" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,018.02" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 12200001 EAP Custom 12200001 Semiprivate Ob BOTH IP/OP "$2,359.00 " "$1,745.66" $0.00 "$1,647.36" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,647.36" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 12200002 EAP Custom 12200002 Tele Semiprivate Ob BOTH IP/OP "$2,391.00 " "$1,769.34" $0.00 "$1,669.54" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,669.54" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 12200501 EAP Custom 12200501 Trauma Semiprivate Ob BOTH IP/OP "$2,700.00 " "$1,998.00" $0.00 "$1,884.96" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,884.96" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 12200502 EAP Custom 12200502 Trauma Tele Semiprivate Ob BOTH IP/OP "$2,732.00 " "$2,021.68" $0.00 "$1,907.14" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,907.14" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 12400002 EAP Custom 12400002 Semiprivate Psych BOTH IP/OP "$2,625.00 " "$1,942.50" $0.00 "$1,833.48" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,833.48" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 12400502 EAP Custom 12400502 Trauma Semiprivate Psych BOTH IP/OP "$2,966.00 " "$2,194.84" $0.00 "$2,071.08" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,071.08" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 16400001 EAP Custom 16400001 Tele.isolation BOTH IP/OP "$3,488.00 " "$2,581.12" $0.00 "$2,435.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,435.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 16400002 EAP Custom 16400002 Isolation Med Surg BOTH IP/OP "$3,362.00 " "$2,487.88" $0.00 "$2,347.49" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,347.49" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 16400004 EAP Custom 16400004 Isolation Med Surg BOTH IP/OP "$3,362.00 " "$2,487.88" $0.00 "$2,347.49" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,347.49" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 16400005 EAP Custom 16400005 Isolation Ob BOTH IP/OP "$3,563.00 " "$2,636.62" $0.00 "$2,488.46" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,488.46" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 16400006 EAP Custom 16400006 Tele.isolation Ob BOTH IP/OP "$3,581.00 " "$2,649.94" $0.00 "$2,500.34" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,500.34" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 16400007 EAP Custom 16400007 Isolation High-risk Scu BOTH IP/OP "$3,953.00 " "$2,925.22" $0.00 "$2,760.12" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,760.12" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 16400022 EAP Custom 16400022 Isolation Gyn BOTH IP/OP "$3,362.00 " "$2,487.88" $0.00 "$2,347.49" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,347.49" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 16400501 EAP Custom 16400501 Trauma Tele.isolation BOTH IP/OP "$3,828.00 " "$2,832.72" $0.00 "$2,673.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,673.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 16400502 EAP Custom 16400502 Trauma Isolation Med Surg BOTH IP/OP "$3,702.00 " "$2,739.48" $0.00 "$2,585.09" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,585.09" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 16400504 EAP Custom 16400504 Trauma Isolation Med Surg BOTH IP/OP "$3,702.00 " "$2,739.48" $0.00 "$2,585.09" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,585.09" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 16400505 EAP Custom 16400505 Trauma Isolation Ob BOTH IP/OP "$3,904.00 " "$2,888.96" $0.00 "$2,726.06" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,726.06" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 16400506 EAP Trauma Tele.isolation Ob BOTH IP/OP "$3,457.00 " "$2,558.18" $0.00 "$2,737.94" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,737.94" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 16400507 EAP Custom 16400507 Trauma Isolation High-risk Scu BOTH IP/OP "$4,293.00 " "$3,176.82" $0.00 "$2,997.72" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,997.72" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 16400522 EAP Custom 16400522 Trauma Isolation Gyn BOTH IP/OP "$3,702.00 " "$2,739.48" $0.00 "$2,585.09" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,585.09" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 17000001 EAP Custom 17000001 General Nursery BOTH IP/OP $849.00 $628.26 $0.00 $592.42 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $592.42 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 17100001 EAP Custom 17100001 NURSERY/LEVEL I BOTH IP/OP "$1,331.00 " $984.94 $0.00 $812.59 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $812.59 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 17100002 EAP Custom 17100002 Nursery Level I BOTH IP/OP "$1,331.00 " $984.94 $0.00 $812.59 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $812.59 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 17200002 EAP Custom 17200002 Nursery Level Ii BOTH IP/OP "$3,458.00 " "$2,558.92" $0.00 "$2,414.81" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,414.81" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 17300001 EAP Custom 17300001 Nursery Level Iii BOTH IP/OP "$5,760.00 " "$4,262.40" $0.00 "$4,021.78" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,021.78" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 17400001 EAP Custom 17400001 Nursery/level Iv BOTH IP/OP "$6,717.00 " "$4,970.58" $0.00 "$4,690.22" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,690.22" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 18000010 EAP Custom 18000010 Leave Of Absence BOTH IP/OP $0.01 $0.01 $0.00 $0.01 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.01 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 19818887 EAP HCPCS A6197 Dressing Wound Square 6x6in 2 Layer Absorbent Nonwoven Soft BOTH IP/OP $55.00 $40.70 $0.00 $44.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $40.82 $40.82 $42.39 $0.00 $11.46 $0.00 $0.00 $0.00 $0.00 $28.00 $44.35 $44.80 $0.00 $35.75 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 19979858 EAP HCPCS C1729 Kit Pressure Monitr Transducer Tipped Catheter Drill Bit BOTH IP/OP "$2,403.00 " "$1,778.22" $0.00 "$1,922.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,201.50" "$1,903.18" "$1,922.40" $0.00 $0.00 $0.00 $376.07 $0.00 $0.00 $382.56 $0.00 $0.00 $0.00 $0.00 $0.00 19988898 EAP Custom 19988898 Catheter Pressure 3.5mm 5mm 82cm 2cm Sensor Tip External BOTH IP/OP $58.00 $42.92 $0.00 $46.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.05 $43.05 $44.71 $0.00 $12.09 $0.00 $0.00 $0.00 $0.00 $29.00 $45.94 $46.40 $0.00 $37.70 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 19993849 EAP HCPCS C1751 Kit Arterial Line .018in 20ga 22ga 1.75in Catheter Radiopq BOTH IP/OP $29.00 $21.46 $0.00 $23.20 $15.75 $15.75 $0.00 $0.00 $0.00 $6.04 $21.52 $21.52 $22.35 $0.00 $6.04 $0.00 $17.15 $17.15 $0.00 $14.50 $22.97 $23.20 $0.00 $18.85 $0.00 $4.54 $0.00 $0.00 $4.62 $0.00 $0.00 $0.00 $0.00 $0.00 19993898 EAP HCPCS C1729 Tray Catheterization 16fr Foley Antireflux Evident Seal BOTH IP/OP $26.00 $19.24 $0.00 $20.80 $14.12 $14.12 $0.00 $0.00 $0.00 $5.42 $19.30 $19.30 $20.04 $0.00 $5.42 $0.00 $15.38 $15.38 $0.00 $13.00 $20.59 $20.80 $0.00 $16.90 $0.00 $4.07 $0.00 $0.00 $4.14 $0.00 $0.00 $0.00 $0.00 $0.00 19994800 EAP Custom 19994800 Kit Crntmy 25ga 5/8in Strl Rzr Ndl Drp BOTH IP/OP $701.00 $518.74 $0.00 "$1,652.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $520.28 $520.28 $540.33 $0.00 $146.09 $0.00 $0.00 $0.00 $0.00 "$1,032.50" "$1,635.48" "$1,652.00" $0.00 $455.65 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 20000001 EAP Custom 20000001 Intensive Care Icu Ob BOTH IP/OP "$6,502.00 " "$4,811.48" $0.00 "$4,539.74" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,539.74" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 20000501 EAP Custom 20000501 Trauma Intensive Care Icu Ob BOTH IP/OP "$6,842.00 " "$5,063.08" $0.00 "$4,777.34" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,777.34" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 20100001 EAP Custom 20100001 Intensive Care Icu Surgical BOTH IP/OP "$6,502.00 " "$4,811.48" $0.00 "$4,539.74" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,539.74" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 20100501 EAP Custom 20100501 Trauma Intensive Care Icu Surgical BOTH IP/OP "$6,875.00 " "$5,087.50" $0.00 "$4,777.34" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,777.34" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 20200001 EAP Custom 20200001 Intensive Care Icu Medical BOTH IP/OP "$6,502.00 " "$4,811.48" $0.00 "$4,539.74" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,539.74" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 20200501 EAP Custom 20200501 Trauma Intensive Care Icu Medical BOTH IP/OP "$6,875.00 " "$5,087.50" $0.00 "$4,777.34" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,777.34" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 20600001 EAP Custom 20600001 Intermediate Care BOTH IP/OP "$4,007.00 " "$2,965.18" $0.00 "$2,782.30" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,782.30" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 20600002 EAP Custom 20600002 Intermediate Care Burn BOTH IP/OP "$9,266.00 " "$6,856.84" $0.00 "$6,450.84" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$6,450.84" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 20600005 EAP Custom 20600005 Intermediate Care BOTH IP/OP "$4,007.00 " "$2,965.18" $0.00 "$2,782.30" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,782.30" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 20600501 EAP Custom 20600501 Trauma Intermediate Care BOTH IP/OP "$4,708.00 " "$3,483.92" $0.00 "$3,019.90" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$3,019.90" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 20600502 EAP Custom 20600502 Trauma Intermediate Care Burn BOTH IP/OP "$9,580.00 " "$7,089.20" $0.00 "$6,688.44" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$6,688.44" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 20700001 EAP Custom 20700001 Intensive Care Icu Burn BOTH IP/OP "$10,118.00 " "$7,487.32" $0.00 "$7,036.13" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$7,036.13" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 20700501 EAP Custom 20700501 Trauma Intensive Care Icu Burn BOTH IP/OP "$10,421.00 " "$7,711.54" $0.00 "$7,273.73" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$7,273.73" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 21000001 EAP Custom 21000001 Intensive Care Icu Medical BOTH IP/OP "$6,502.00 " "$4,811.48" $0.00 "$4,539.74" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,539.74" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 21400005 EAP Intermediate Coronary Care Unit BOTH IP/OP "$4,793.00 " "$3,546.82" $0.00 "$3,318.48" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$3,318.48" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 21400505 EAP Custom 21400505 Trauma Intermediate Coronary Care Unit BOTH IP/OP "$5,219.00 " "$3,862.06" $0.00 "$3,556.08" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$3,556.08" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 21900001 EAP Custom 21900001 Intermediate Care BOTH IP/OP "$3,741.00 " "$2,768.34" $0.00 "$2,782.30" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,782.30" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25000134 EAP Custom 25000134 Rocephin 250mg BOTH IP/OP $15.00 $11.10 $0.00 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $3.13 $0.00 $0.00 $0.00 $0.00 $7.50 $11.88 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25000141 EAP Custom 25000141 Toradol 30 Mg BOTH IP/OP $37.00 $27.38 $0.00 $29.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $27.46 $27.46 $28.52 $0.00 $7.71 $0.00 $0.00 $0.00 $0.00 $18.50 $29.30 $29.60 $0.00 $24.05 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25000153 EAP Custom 25000153 "Rocephin 250mg, Im" BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $38.35 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25000157 EAP Custom 25000157 Depoprovera 150mg BOTH IP/OP $180.00 $133.20 $0.00 $144.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $133.60 $133.60 $138.74 $0.00 $37.51 $0.00 $0.00 $0.00 $0.00 $90.00 $142.56 $144.00 $0.00 $117.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25000169 EAP Custom 25000169 Vit B 12 100mcg BOTH IP/OP $46.00 $34.04 $0.00 $36.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $34.14 $34.14 $35.46 $0.00 $9.59 $0.00 $0.00 $0.00 $0.00 $23.00 $36.43 $36.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25000182 EAP Custom 25000182 Rocephin Injection BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $38.35 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25000187 EAP Custom 25000187 Rocephin 250mg BOTH IP/OP $34.00 $25.16 $0.00 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $25.23 $25.23 $26.21 $0.00 $7.09 $0.00 $0.00 $0.00 $0.00 $17.00 $26.93 $27.20 $0.00 $15.30 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25000189 EAP Custom 25000189 Bicillin Injection BOTH IP/OP $44.00 $32.56 $0.00 $35.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $32.66 $32.66 $33.92 $0.00 $9.17 $0.00 $0.00 $0.00 $0.00 $22.00 $34.85 $35.20 $0.00 $28.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25000224 EAP Custom 25000224 Rocephin 250mg (cef BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25000226 EAP Custom 25000226 Depo Provera Inject BOTH IP/OP $171.00 $126.54 $0.00 $136.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $126.92 $126.92 $131.81 $0.00 $35.64 $0.00 $0.00 $0.00 $0.00 $85.50 $135.43 $136.80 $0.00 $111.15 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25000227 EAP Custom 25000227 Oral Contraceptives BOTH IP/OP $13.00 $9.62 $0.00 $10.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $2.71 $0.00 $0.00 $0.00 $0.00 $6.50 $10.30 $10.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25000229 EAP Custom 25000229 Plan B BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $25.35 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25000230 EAP Custom 25000230 Evra Transdermal Pa BOTH IP/OP $20.00 $14.80 $0.00 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $4.17 $0.00 $0.00 $0.00 $0.00 $10.00 $15.84 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25000327 EAP Custom 25000327 Oral Contraceptives BOTH IP/OP $11.00 $8.14 $0.00 $8.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $8.16 $8.16 $8.48 $0.00 $2.29 $0.00 $0.00 $0.00 $0.00 $5.50 $8.71 $8.80 $0.00 $7.15 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25000908 EAP Custom 25000908 Evra Trandermal Pat BOTH IP/OP $17.00 $12.58 $0.00 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $3.54 $0.00 $0.00 $0.00 $0.00 $8.50 $13.46 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25000960 EAP Custom 25000960 Hetastarch (hespan) BOTH IP/OP $435.00 $321.90 $0.00 $348.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $322.86 $322.86 $335.30 $0.00 $90.65 $0.00 $0.00 $0.00 $0.00 $217.50 $344.52 $348.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25000961 EAP Custom 25000961 Hetastarch BOTH IP/OP $435.00 $321.90 $0.00 $348.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $322.86 $322.86 $335.30 $0.00 $90.65 $0.00 $0.00 $0.00 $0.00 $217.50 $344.52 $348.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25000966 EAP Custom 25000966 "Rocephin 250mg, 1gm" BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25000990 EAP Custom 25000990 Nitric Oxide (per Hr) BOTH IP/OP $789.00 $583.86 $0.00 $631.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $585.60 $585.60 $608.16 $0.00 $164.43 $0.00 $0.00 $0.00 $0.00 $394.50 $624.89 $631.20 $0.00 $512.85 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25002130 EAP Custom 25002130 Zithromax BOTH IP/OP $24.00 $17.76 $0.00 $19.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $17.81 $17.81 $18.50 $0.00 $5.00 $0.00 $0.00 $0.00 $0.00 $12.00 $19.01 $19.20 $0.00 $15.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25500016 EAP HCPCS Q9965 Locm 150-199mg/ml I BOTH IP/OP $6.00 $4.44 $0.00 $4.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $4.45 $4.45 $0.00 $0.00 $1.05 $0.00 $0.00 $0.00 $0.00 $3.00 $4.75 $4.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25500039 EAP HCPCS Q9965 Locm 150-199mg/ml I BOTH IP/OP $6.00 $4.44 $0.00 $4.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $4.45 $4.45 $0.00 $0.00 $1.05 $0.00 $0.00 $0.00 $0.00 $3.00 $4.75 $4.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800010 EAP Custom 25800010 Solutions Sodium Ch BOTH IP/OP $49.00 $36.26 $0.00 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $36.37 $36.37 $37.77 $0.00 $10.21 $0.00 $0.00 $0.00 $0.00 $24.50 $38.81 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800013 EAP Custom 25800013 Solution Iv D 5% In BOTH IP/OP $49.00 $36.26 $0.00 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $36.37 $36.37 $37.77 $0.00 $10.21 $0.00 $0.00 $0.00 $0.00 $24.50 $38.81 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800016 EAP Custom 25800016 Solution Iv Lactate BOTH IP/OP $49.00 $36.26 $0.00 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $36.37 $36.37 $37.77 $0.00 $10.21 $0.00 $0.00 $0.00 $0.00 $24.50 $38.81 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800017 EAP Custom 25800017 Solution Iv Nacl 0. BOTH IP/OP $49.00 $36.26 $0.00 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $36.37 $36.37 $37.77 $0.00 $10.21 $0.00 $0.00 $0.00 $0.00 $24.50 $38.81 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800018 EAP Custom 25800018 Solution Iv Nacl 0. BOTH IP/OP $49.00 $36.26 $0.00 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $36.37 $36.37 $37.77 $0.00 $10.21 $0.00 $0.00 $0.00 $0.00 $24.50 $38.81 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800019 EAP Custom 25800019 Solution Iv Nacl 0. BOTH IP/OP $49.00 $36.26 $0.00 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $36.37 $36.37 $37.77 $0.00 $10.21 $0.00 $0.00 $0.00 $0.00 $24.50 $38.81 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800020 EAP Custom 25800020 Solution Iv Nacl 0. BOTH IP/OP $49.00 $36.26 $0.00 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $36.37 $36.37 $37.77 $0.00 $10.21 $0.00 $0.00 $0.00 $0.00 $24.50 $38.81 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800031 EAP Custom 25800031 Solution Iv D 5% In BOTH IP/OP $49.00 $36.26 $0.00 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $36.37 $36.37 $37.77 $0.00 $10.21 $0.00 $0.00 $0.00 $0.00 $24.50 $38.81 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800033 EAP Custom 25800033 Solution Iv Lactate BOTH IP/OP $49.00 $36.26 $0.00 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $36.37 $36.37 $37.77 $0.00 $10.21 $0.00 $0.00 $0.00 $0.00 $24.50 $38.81 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800034 EAP Custom 25800034 Solution Iv Nacl 0. BOTH IP/OP $49.00 $36.26 $0.00 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $36.37 $36.37 $37.77 $0.00 $10.21 $0.00 $0.00 $0.00 $0.00 $24.50 $38.81 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800037 EAP Custom 25800037 Solution Iv Nacl 0. BOTH IP/OP $49.00 $36.26 $0.00 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $36.37 $36.37 $37.77 $0.00 $10.21 $0.00 $0.00 $0.00 $0.00 $24.50 $38.81 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800038 EAP Custom 25800038 Solution Iv Nacl 0. BOTH IP/OP $49.00 $36.26 $0.00 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $36.37 $36.37 $37.77 $0.00 $10.21 $0.00 $0.00 $0.00 $0.00 $24.50 $38.81 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800039 EAP Custom 25800039 Solution Iv Nacl 0. BOTH IP/OP $49.00 $36.26 $0.00 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $36.37 $36.37 $37.77 $0.00 $10.21 $0.00 $0.00 $0.00 $0.00 $24.50 $38.81 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800060 EAP Custom 25800060 Iv Fluids BOTH IP/OP $61.00 $45.14 $0.00 $48.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $45.27 $45.27 $47.02 $0.00 $12.71 $0.00 $0.00 $0.00 $0.00 $30.50 $48.31 $48.80 $0.00 $39.65 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800061 EAP Custom 25800061 Iv Fluids BOTH IP/OP $61.00 $45.14 $0.00 $48.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $45.27 $45.27 $47.02 $0.00 $12.71 $0.00 $0.00 $0.00 $0.00 $30.50 $48.31 $48.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800062 EAP Custom 25800062 I.v. Fluids 500ml BOTH IP/OP $64.00 $47.36 $0.00 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $47.50 $47.50 $49.33 $0.00 $13.34 $0.00 $0.00 $0.00 $0.00 $32.00 $50.69 $51.20 $0.00 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800063 EAP Custom 25800063 I.v. Fluid 100ml BOTH IP/OP $64.00 $47.36 $0.00 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $47.50 $47.50 $49.33 $0.00 $13.34 $0.00 $0.00 $0.00 $0.00 $32.00 $50.69 $51.20 $0.00 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800080 EAP Custom 25800080 Iv Fluids 1000ml BOTH IP/OP $64.00 $47.36 $0.00 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $47.50 $47.50 $49.33 $0.00 $13.34 $0.00 $0.00 $0.00 $0.00 $32.00 $50.69 $51.20 $0.00 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800095 EAP Custom 25800095 Solution Iv Water For Irr BOTH IP/OP $49.00 $36.26 $0.00 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $36.37 $36.37 $37.77 $0.00 $10.21 $0.00 $0.00 $0.00 $0.00 $24.50 $38.81 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800260 EAP Custom 25800260 Iv Fluid 500ml BOTH IP/OP $64.00 $47.36 $0.00 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $32.00 $50.69 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800262 EAP Custom 25800262 Solutions Advantage Glou BOTH IP/OP $49.00 $36.26 $0.00 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $36.37 $36.37 $37.77 $0.00 $10.21 $0.00 $0.00 $0.00 $0.00 $24.50 $38.81 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800263 EAP Custom 25800263 Solution Irrigation Water 150 BOTH IP/OP $49.00 $36.26 $0.00 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $36.37 $36.37 $37.77 $0.00 $10.21 $0.00 $0.00 $0.00 $0.00 $24.50 $38.81 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800264 EAP Custom 25800264 Solutions Iv Water For Inject BOTH IP/OP $49.00 $36.26 $0.00 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $36.37 $36.37 $37.77 $0.00 $10.21 $0.00 $0.00 $0.00 $0.00 $24.50 $38.81 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800265 EAP Custom 25800265 Solutions Sodium Chloride BOTH IP/OP $37.00 $27.38 $0.00 $29.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $27.46 $27.46 $28.52 $0.00 $7.71 $0.00 $0.00 $0.00 $0.00 $18.50 $29.30 $29.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800267 EAP Custom 25800267 "Iv Fluids, 100cc" BOTH IP/OP $34.00 $25.16 $0.00 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $25.23 $25.23 $26.21 $0.00 $7.09 $0.00 $0.00 $0.00 $0.00 $17.00 $26.93 $27.20 $0.00 $22.10 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800268 EAP Custom 25800268 "Iv Fluids, 500cc" BOTH IP/OP $64.00 $47.36 $0.00 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $47.50 $47.50 $49.33 $0.00 $13.34 $0.00 $0.00 $0.00 $0.00 $32.00 $50.69 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800269 EAP Custom 25800269 "Iv Fluids, 1000cc" BOTH IP/OP $64.00 $47.36 $0.00 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $47.50 $47.50 $49.33 $0.00 $13.34 $0.00 $0.00 $0.00 $0.00 $32.00 $50.69 $51.20 $0.00 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800274 EAP Custom 25800274 Solution Iv Nacl 0.9% Gla BOTH IP/OP $49.00 $36.26 $0.00 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $36.37 $36.37 $37.77 $0.00 $10.21 $0.00 $0.00 $0.00 $0.00 $24.50 $38.81 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800277 EAP Custom 25800277 Solution Iv Nacl 0.9% 50m BOTH IP/OP $49.00 $36.26 $0.00 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $36.37 $36.37 $37.77 $0.00 $10.21 $0.00 $0.00 $0.00 $0.00 $24.50 $38.81 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800278 EAP Custom 25800278 "Iv Fluids, 50cc" BOTH IP/OP $34.00 $25.16 $0.00 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $25.23 $25.23 $26.21 $0.00 $7.09 $0.00 $0.00 $0.00 $0.00 $17.00 $26.93 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800401 EAP Custom 25800401 I.v. Fluids BOTH IP/OP $64.00 $47.36 $0.00 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $47.50 $47.50 $49.33 $0.00 $13.34 $0.00 $0.00 $0.00 $0.00 $32.00 $50.69 $51.20 $0.00 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800402 EAP Custom 25800402 I.v. Fluids 1000cc BOTH IP/OP $64.00 $47.36 $0.00 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $47.50 $47.50 $49.33 $0.00 $13.34 $0.00 $0.00 $0.00 $0.00 $32.00 $50.69 $51.20 $0.00 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800403 EAP Custom 25800403 I.v. Fluids 500ml BOTH IP/OP $64.00 $47.36 $0.00 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $32.00 $50.69 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800404 EAP Custom 25800404 Iv Fluid 1000cc BOTH IP/OP $64.00 $47.36 $0.00 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $47.50 $47.50 $49.33 $0.00 $13.34 $0.00 $0.00 $0.00 $0.00 $32.00 $50.69 $51.20 $0.00 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800405 EAP Custom 25800405 "Iv Fluid, # Bags" BOTH IP/OP $61.00 $45.14 $0.00 $48.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $45.27 $45.27 $47.02 $0.00 $12.71 $0.00 $0.00 $0.00 $0.00 $30.50 $48.31 $48.80 $0.00 $39.65 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800406 EAP Custom 25800406 "Iv Fluid, #bags" BOTH IP/OP $61.00 $45.14 $0.00 $48.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $45.27 $45.27 $47.02 $0.00 $12.71 $0.00 $0.00 $0.00 $0.00 $30.50 $48.31 $48.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800407 EAP Custom 25800407 Iv Fluids 1000ml BOTH IP/OP $64.00 $47.36 $0.00 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $47.50 $47.50 $49.33 $0.00 $13.34 $0.00 $0.00 $0.00 $0.00 $32.00 $50.69 $51.20 $0.00 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800408 EAP Custom 25800408 Iv Fluids 500cc BOTH IP/OP $64.00 $47.36 $0.00 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $47.50 $47.50 $49.33 $0.00 $13.34 $0.00 $0.00 $0.00 $0.00 $32.00 $50.69 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800409 EAP Custom 25800409 Iv Fluids 50cc BOTH IP/OP $34.00 $25.16 $0.00 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $25.23 $25.23 $26.21 $0.00 $7.09 $0.00 $0.00 $0.00 $0.00 $17.00 $26.93 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800410 EAP Custom 25800410 Iv Fluids-500ml BOTH IP/OP $64.00 $47.36 $0.00 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $47.50 $47.50 $49.33 $0.00 $13.34 $0.00 $0.00 $0.00 $0.00 $32.00 $50.69 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800411 EAP Custom 25800411 Solution Intravenous Viaflex Latex Free Plasma-lyte A BOTH IP/OP $29.00 $21.46 $0.00 $23.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $21.52 $21.52 $22.35 $0.00 $6.04 $0.00 $0.00 $0.00 $0.00 $14.50 $22.97 $23.20 $0.00 $18.85 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25800412 EAP Custom 25800412 Solution Irr 0.9% Na Chlor Urmtc 3l Strl Lf BOTH IP/OP $27.00 $19.98 $0.00 $21.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $20.04 $20.04 $20.81 $0.00 $5.63 $0.00 $0.00 $0.00 $0.00 $13.50 $21.38 $21.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25900227 EAP Custom 25900227 Oral Contraceptives BOTH IP/OP $12.00 $8.88 $0.00 $9.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $8.91 $8.91 $9.25 $0.00 $2.50 $0.00 $0.00 $0.00 $0.00 $6.00 $9.50 $9.60 $0.00 $7.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 25900255 EAP Custom 25900255 Insulin 5 Units BOTH IP/OP $4.00 $2.96 $0.00 $3.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $2.97 $2.97 $3.08 $0.00 $0.83 $0.00 $0.00 $0.00 $0.00 $2.00 $3.17 $3.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 26000001 EAP CPT® 96360 Iv Hydra Initial (31 Min To 1 Hr) BOTH IP/OP "$1,030.00 " $762.20 $34.59 $793.92 $559.29 $559.29 $199.22 $199.22 $200.34 $214.68 $764.47 $764.47 $793.92 $195.04 $214.65 $126.78 $609.25 $609.25 $184.28 $440.50 $697.75 $704.80 $256.03 $669.50 $256.03 $53.93 $34.59 $34.59 $140.26 $175.50 $0.00 $0.00 $0.00 $0.00 26000003 EAP CPT® 96361 Iv Hydra Add'l (31 Min To 1 Hr) BOTH IP/OP $347.00 $256.78 $13.69 $267.47 $188.42 $188.42 $38.97 $38.97 $39.19 $72.32 $257.54 $257.54 $267.47 $38.34 $72.31 $24.92 $205.25 $205.25 $38.22 $148.00 $234.43 $236.80 $53.10 $225.55 $53.10 $15.67 $13.69 $13.69 $47.12 $36.40 $0.00 $0.00 $0.00 $0.00 26000005 EAP CPT® 96365 "Iv Infus Ther,prophylax,dx Initial (16 Min To 1 Hr)" BOTH IP/OP "$1,796.00 " "$1,329.04" $65.68 "$1,384.36" $975.23 $975.23 $199.22 $199.22 $200.34 $374.33 "$1,332.99" "$1,332.99" "$1,384.36" $195.04 $374.29 $126.78 "$1,062.33" "$1,062.33" $184.28 $769.00 "$1,218.10" "$1,230.40" $256.03 "$1,167.40" $256.03 $65.68 $72.05 $72.05 $244.85 $175.50 $0.00 $0.00 $0.00 $0.00 26000006 EAP CPT® 96366 "Iv Infus Ther,prophylax,dx Add'l (31 Min To 1 Hr)" BOTH IP/OP $347.00 $256.78 $20.85 $267.47 $188.42 $188.42 $38.97 $38.97 $39.19 $72.32 $257.54 $257.54 $267.47 $38.34 $72.31 $24.92 $205.25 $205.25 $38.22 $148.00 $234.43 $236.80 $53.10 $225.55 $53.10 $20.85 $21.98 $21.98 $47.12 $36.40 $0.00 $0.00 $0.00 $0.00 26000007 EAP CPT® 96367 "Iv Infus Ther,prophylax,dx Add'l New Med (31 Min To 1 Hr)" BOTH IP/OP $523.00 $387.02 $31.35 $403.13 $283.99 $283.99 $60.38 $60.38 $60.72 $109.01 $388.17 $388.17 $403.13 $59.39 $108.99 $38.61 $309.35 $309.35 $60.65 $223.50 $354.02 $357.60 $84.26 $339.95 $84.26 $32.97 $31.35 $31.35 $71.16 $57.76 $0.00 $0.00 $0.00 $0.00 26000008 EAP CPT® 96368 "Iv Infus Ther,prophylax,dx Add'l Concur (31 Min To 1 Hr)" BOTH IP/OP $630.00 $466.20 $0.00 $485.60 $342.09 $342.09 $0.00 $0.00 $0.00 $131.31 $467.59 $467.59 $485.60 $0.00 $131.29 $0.00 $372.65 $372.65 $0.00 $245.00 $388.08 $392.00 $0.00 $480.35 $0.00 $19.47 $21.26 $21.26 $78.01 $0.00 $0.00 $0.00 $0.00 $0.00 26000111 EAP CPT® 96374 "Iv Push - Ther,prophylax,dx 1st Med" BOTH IP/OP $630.00 $466.20 $39.99 $485.60 $342.09 $342.09 $199.22 $199.22 $200.34 $131.31 $467.59 $467.59 $485.60 $195.04 $131.29 $126.78 $372.65 $372.65 $184.28 $245.00 $388.08 $392.00 $256.03 $409.50 $256.03 $52.02 $39.99 $39.99 $78.01 $175.50 $0.00 $0.00 $0.00 $0.00 26000112 EAP CPT® 96375 "Iv Push - Ther,prophylax,dx Add'l Med" BOTH IP/OP $523.00 $387.02 $16.57 $403.13 $283.99 $283.99 $38.97 $38.97 $39.19 $109.01 $388.17 $388.17 $403.13 $38.34 $108.99 $24.92 $309.35 $309.35 $38.22 $223.50 $354.02 $357.60 $53.10 $339.95 $53.10 $22.60 $16.57 $16.57 $71.16 $36.40 $0.00 $0.00 $0.00 $0.00 26000113 EAP CPT® 96376 "Iv Push - Ther,prophylax,dx Ea Push Same Med" BOTH IP/OP $349.00 $258.26 $0.00 $269.01 $189.51 $189.51 $0.00 $0.00 $0.00 $72.74 $259.03 $259.03 $269.01 $0.00 $72.73 $0.00 $206.43 $206.43 $0.00 $149.00 $236.02 $238.40 $0.00 $226.85 $0.00 $46.64 $0.00 $0.00 $47.44 $0.00 $0.00 $0.00 $0.00 $0.00 26000114 EAP CPT® 96523 Picc/portacath Line Flush BOTH IP/OP $282.00 $208.68 $27.46 $319.15 $73.05 $73.05 $54.21 $54.21 $54.51 $58.78 $209.30 $209.30 $217.37 $53.35 $58.77 $34.67 $166.80 $166.80 $55.17 $120.50 $190.87 $192.80 $76.65 $319.15 $76.65 $27.46 $28.10 $28.10 $38.37 $52.54 $0.00 $0.00 $0.00 $0.00 27000010 EAP Custom 27000010 Tube Salem Sump 48 Lengt BOTH IP/OP $16.00 $11.84 $0.00 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.88 $11.88 $12.33 $0.00 $3.33 $0.00 $0.00 $0.00 $0.00 $8.00 $12.67 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000011 EAP Custom 27000011 Tube Salem Silicone Size BOTH IP/OP $16.00 $11.84 $0.00 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.88 $11.88 $12.33 $0.00 $3.33 $0.00 $0.00 $0.00 $0.00 $8.00 $12.67 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000012 EAP Custom 27000012 Tubes Salem Sump 48 Leng BOTH IP/OP $16.00 $11.84 $0.00 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.88 $11.88 $12.33 $0.00 $3.33 $0.00 $0.00 $0.00 $0.00 $8.00 $12.67 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000015 EAP Custom 27000015 Scapel Surg W/handle Atta BOTH IP/OP $142.00 $105.08 $0.00 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $105.39 $105.39 $109.45 $0.00 $29.59 $0.00 $0.00 $0.00 $0.00 $71.00 $112.46 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000016 EAP Custom 27000016 Scaple Surg W/handle Atta BOTH IP/OP $152.00 $112.48 $0.00 $121.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $112.81 $112.81 $117.16 $0.00 $31.68 $0.00 $0.00 $0.00 $0.00 $76.00 $120.38 $121.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000019 EAP Custom 27000019 Kit L.f. Trach Care BOTH IP/OP $511.00 $378.14 $0.00 $408.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $379.26 $379.26 $393.88 $0.00 $106.49 $0.00 $0.00 $0.00 $0.00 $255.50 $404.71 $408.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000024 EAP Custom 27000024 Bag 1000ml Pump Set BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000026 EAP Custom 27000026 Kit Triple Lumen Catheter BOTH IP/OP $587.00 $434.38 $0.00 $469.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $435.67 $435.67 $452.46 $0.00 $122.33 $0.00 $0.00 $0.00 $0.00 $293.50 $464.90 $469.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000027 EAP Custom 27000027 Filter Set 0.22 Micron BOTH IP/OP $20.00 $14.80 $0.00 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.84 $14.84 $15.42 $0.00 $4.17 $0.00 $0.00 $0.00 $0.00 $10.00 $15.84 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000029 EAP Custom 27000029 Set T-port Small Bore Ext BOTH IP/OP $14.00 $10.36 $0.00 $11.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $10.39 $10.39 $10.79 $0.00 $2.92 $0.00 $0.00 $0.00 $0.00 $7.00 $11.09 $11.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000031 EAP Custom 27000031 Tray Douch Disposable BOTH IP/OP $69.00 $51.06 $0.00 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $51.21 $51.21 $53.19 $0.00 $14.38 $0.00 $0.00 $0.00 $0.00 $34.50 $54.65 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000033 EAP Custom 27000033 Tray Foley Preconnected 1 BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000034 EAP Custom 27000034 Tray Foley Perconnected 1 BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000035 EAP Custom 27000035 Tray Thoracentesis Dispos BOTH IP/OP $134.00 $99.16 $0.00 $188.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $99.45 $99.45 $103.29 $0.00 $27.93 $0.00 $0.00 $0.00 $0.00 $117.50 $186.12 $188.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000036 EAP Custom 27000036 Central Line Dressing Tray With Biopatch BOTH IP/OP $47.00 $34.78 $0.00 $37.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $34.88 $34.88 $36.23 $0.00 $9.79 $0.00 $0.00 $0.00 $0.00 $23.50 $37.22 $37.60 $0.00 $30.55 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000045 EAP Custom 27000045 Sleeve Knee Regular Dvt BOTH IP/OP $388.00 $287.12 $0.00 $310.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $287.97 $287.97 $299.07 $0.00 $80.86 $0.00 $0.00 $0.00 $0.00 $194.00 $307.30 $310.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000046 EAP Custom 27000046 Sleeve Knee X-large Dvt BOTH IP/OP $469.00 $347.06 $0.00 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $348.09 $348.09 $361.51 $0.00 $97.74 $0.00 $0.00 $0.00 $0.00 $234.50 $371.45 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000047 EAP Custom 27000047 Sleeve Thigh Regular Dvt BOTH IP/OP $553.00 $409.22 $0.00 $442.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $410.44 $410.44 $426.25 $0.00 $115.25 $0.00 $0.00 $0.00 $0.00 $276.50 $437.98 $442.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000048 EAP Custom 27000048 Sleeve Thigh X-large Dvt BOTH IP/OP $663.00 $490.62 $0.00 $530.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $492.08 $492.08 $511.04 $0.00 $138.17 $0.00 $0.00 $0.00 $0.00 $331.50 $525.10 $530.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000066 EAP Custom 27000066 "Tray,instrumen 13-1/2x9/34x5/8" BOTH IP/OP $391.00 $289.34 $0.00 $312.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $290.20 $290.20 $301.38 $0.00 $81.48 $0.00 $0.00 $0.00 $0.00 $195.50 $309.67 $312.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000076 EAP HCPCS C1729 Catheter Coude Size 14fr BOTH IP/OP $44.00 $32.56 $0.00 $35.20 $23.89 $23.89 $0.00 $0.00 $0.00 $9.17 $32.66 $32.66 $33.92 $0.00 $9.17 $0.00 $26.03 $26.03 $0.00 $22.00 $34.85 $35.20 $0.00 $0.00 $0.00 $6.89 $0.00 $0.00 $7.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000078 EAP Custom 27000078 Tubes Salem Sump 48 Leng BOTH IP/OP $16.00 $11.84 $0.00 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.88 $11.88 $12.33 $0.00 $3.33 $0.00 $0.00 $0.00 $0.00 $8.00 $12.67 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000079 EAP Custom 27000079 Kit Tracheotomy Care Ster BOTH IP/OP $30.00 $22.20 $0.00 $24.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $22.27 $22.27 $23.12 $0.00 $6.25 $0.00 $0.00 $0.00 $0.00 $15.00 $23.76 $24.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000081 EAP Custom 27000081 Scapel Surg W/ Handle Attached BOTH IP/OP $132.00 $97.68 $0.00 $105.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $97.97 $97.97 $101.75 $0.00 $27.51 $0.00 $0.00 $0.00 $0.00 $66.00 $104.54 $105.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000087 EAP Custom 27000087 Kit Thoracotomy BOTH IP/OP $203.00 $150.22 $0.00 $162.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $150.67 $150.67 $156.47 $0.00 $42.31 $0.00 $0.00 $0.00 $0.00 $101.50 $160.78 $162.40 $0.00 $131.95 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000093 EAP Custom 27000093 Bag 1000ml Pump Set BOTH IP/OP $28.00 $20.72 $0.00 $22.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $20.78 $20.78 $21.58 $0.00 $5.84 $0.00 $0.00 $0.00 $0.00 $14.00 $22.18 $22.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000094 EAP Custom 27000094 Chest Unit Drainage Pleur BOTH IP/OP $455.00 $336.70 $0.00 $364.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $337.70 $337.70 $350.71 $0.00 $94.82 $0.00 $0.00 $0.00 $0.00 $227.50 $360.36 $364.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000097 EAP Custom 27000097 Kit Triple Lumen Catheter BOTH IP/OP $299.00 $221.26 $0.00 $239.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $221.92 $221.92 $230.47 $0.00 $62.31 $0.00 $0.00 $0.00 $0.00 $149.50 $236.81 $239.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000098 EAP Custom 27000098 Vest Econo Cotton Small BOTH IP/OP $94.00 $69.56 $0.00 $75.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $69.77 $69.77 $72.46 $0.00 $19.59 $0.00 $0.00 $0.00 $0.00 $47.00 $74.45 $75.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000101 EAP Custom 27000101 Vest Econo Cotton X-large BOTH IP/OP $109.00 $80.66 $0.00 $87.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $80.90 $80.90 $84.02 $0.00 $22.72 $0.00 $0.00 $0.00 $0.00 $54.50 $86.33 $87.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000103 EAP Custom 27000103 Filter Set 0.22 Micron BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $0.00 $0.00 $0.00 $9.50 $15.05 $15.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000107 EAP Custom 27000107 Tray Foley Perconnected 1 BOTH IP/OP $52.00 $38.48 $0.00 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $38.59 $38.59 $40.08 $0.00 $10.84 $0.00 $0.00 $0.00 $0.00 $26.00 $41.18 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000109 EAP Custom 27000109 Tray Thoracentesis Dispos BOTH IP/OP $235.00 $173.90 $0.00 $188.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $174.42 $174.42 $181.14 $0.00 $48.97 $0.00 $0.00 $0.00 $0.00 $117.50 $186.12 $188.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000119 EAP Custom 27000119 3ml Posiflush Saline Syringe BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000125 EAP Custom 27000125 Sleeve Thigh Regular Dvt BOTH IP/OP $469.00 $347.06 $0.00 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $348.09 $348.09 $361.51 $0.00 $97.74 $0.00 $0.00 $0.00 $0.00 $234.50 $371.45 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000127 EAP Custom 27000127 "Tray,catheter Instrument Dulmn" BOTH IP/OP $718.00 $531.32 $0.00 $574.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $532.90 $532.90 $553.43 $0.00 $149.63 $0.00 $0.00 $0.00 $0.00 $359.00 $568.66 $574.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000150 EAP Custom 27000150 Catheter Urethral Two-eye BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000151 EAP HCPCS C1729 Catheter Coude Size 14fr BOTH IP/OP $109.00 $80.66 $0.00 $87.20 $59.19 $59.19 $0.00 $0.00 $0.00 $22.72 $80.90 $80.90 $84.02 $0.00 $22.72 $0.00 $64.47 $64.47 $0.00 $54.50 $86.33 $87.20 $0.00 $0.00 $0.00 $17.06 $0.00 $0.00 $17.35 $0.00 $0.00 $0.00 $0.00 $0.00 27000152 EAP HCPCS C1729 Catheter Coude 30cc 24fr BOTH IP/OP $87.00 $64.38 $0.00 $69.60 $47.24 $47.24 $0.00 $0.00 $0.00 $18.13 $64.57 $64.57 $67.06 $0.00 $18.13 $0.00 $51.46 $51.46 $0.00 $43.50 $68.90 $69.60 $0.00 $0.00 $0.00 $13.62 $0.00 $0.00 $13.85 $0.00 $0.00 $0.00 $0.00 $0.00 27000153 EAP Custom 27000153 Tube Salem Silicone Size BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000154 EAP Custom 27000154 Tubes Salem Sump 48 Leng BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000155 EAP Custom 27000155 Kit Tracheotomy Care Ster BOTH IP/OP $65.00 $48.10 $0.00 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $48.24 $48.24 $50.10 $0.00 $13.55 $0.00 $0.00 $0.00 $0.00 $32.50 $51.48 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000168 EAP Custom 27000168 Bag 1000ml Pump Set BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000169 EAP Custom 27000169 Chest Unit Drainage Pleur BOTH IP/OP $455.00 $336.70 $0.00 $364.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $337.70 $337.70 $350.71 $0.00 $94.82 $0.00 $0.00 $0.00 $0.00 $227.50 $360.36 $364.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000173 EAP Custom 27000173 Tube Feeding Ng 8fr 36in Entr BOTH IP/OP $65.00 $48.10 $0.00 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $48.24 $48.24 $50.10 $0.00 $13.55 $0.00 $0.00 $0.00 $0.00 $32.50 $51.48 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000174 EAP Custom 27000174 Kit Triple Lumen Catheter BOTH IP/OP $299.00 $221.26 $0.00 $239.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $221.92 $221.92 $230.47 $0.00 $62.31 $0.00 $0.00 $0.00 $0.00 $149.50 $236.81 $239.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000179 EAP Custom 27000179 Filter Set 0.22 Micron BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $0.00 $0.00 $0.00 $9.50 $15.05 $15.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000181 EAP Custom 27000181 Tray Foley Preconnected 1 BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000182 EAP Custom 27000182 Tray Foley Perconnected 1 BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000184 EAP Custom 27000184 Tray Thoracentesis Dispos BOTH IP/OP $235.00 $173.90 $0.00 $188.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $174.42 $174.42 $181.14 $0.00 $48.97 $0.00 $0.00 $0.00 $0.00 $117.50 $186.12 $188.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000191 EAP Custom 27000191 "Suture,silk, 0" BOTH IP/OP $15.00 $11.10 $0.00 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.13 $11.13 $11.56 $0.00 $3.13 $0.00 $0.00 $0.00 $0.00 $7.50 $11.88 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000197 EAP Custom 27000197 Sleeve Knee Regular Dvt BOTH IP/OP $388.00 $287.12 $0.00 $310.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $287.97 $287.97 $299.07 $0.00 $80.86 $0.00 $0.00 $0.00 $0.00 $194.00 $307.30 $310.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000198 EAP Custom 27000198 Sleeve Knee X-large Dvt BOTH IP/OP $469.00 $347.06 $0.00 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $348.09 $348.09 $361.51 $0.00 $97.74 $0.00 $0.00 $0.00 $0.00 $234.50 $371.45 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000199 EAP Custom 27000199 Sleeve Thigh Regular Dvt BOTH IP/OP $553.00 $409.22 $0.00 $442.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $410.44 $410.44 $426.25 $0.00 $115.25 $0.00 $0.00 $0.00 $0.00 $276.50 $437.98 $442.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000200 EAP Custom 27000200 Sleeve Thigh X-large Dvt BOTH IP/OP $663.00 $490.62 $0.00 $530.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $492.08 $492.08 $511.04 $0.00 $138.17 $0.00 $0.00 $0.00 $0.00 $331.50 $525.10 $530.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000222 EAP Custom 27000222 Catheter Urethral 14fr BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000223 EAP Custom 27000223 Catheter Urethral Two-eye BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000224 EAP Custom 27000224 Tube Salem Sump 48 Lengt BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000225 EAP Custom 27000225 Tubes Salem Sump 48 Leng BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000226 EAP Custom 27000226 Kit Tracheotomy Care Ster BOTH IP/OP $65.00 $48.10 $0.00 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $48.24 $48.24 $50.10 $0.00 $13.55 $0.00 $0.00 $0.00 $0.00 $32.50 $51.48 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000228 EAP Custom 27000228 Scapel Surg W/handle Atta BOTH IP/OP $142.00 $105.08 $0.00 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $105.39 $105.39 $109.45 $0.00 $29.59 $0.00 $0.00 $0.00 $0.00 $71.00 $112.46 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000232 EAP Custom 27000232 Cream Baza 5oz BOTH IP/OP $56.00 $41.44 $0.00 $44.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $41.56 $41.56 $43.16 $0.00 $11.67 $0.00 $0.00 $0.00 $0.00 $28.00 $44.35 $44.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000240 EAP Custom 27000240 Bag 1000ml Pump Set BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000241 EAP Custom 27000241 Needle Port-cath 20ga X 1 BOTH IP/OP $36.00 $26.64 $0.00 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $26.72 $26.72 $27.75 $0.00 $7.50 $0.00 $0.00 $0.00 $0.00 $18.00 $28.51 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000242 EAP Custom 27000242 Chest Unit Drainage Pleur BOTH IP/OP $455.00 $336.70 $0.00 $364.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $337.70 $337.70 $350.71 $0.00 $94.82 $0.00 $0.00 $0.00 $0.00 $227.50 $360.36 $364.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000245 EAP Custom 27000245 Kit Triple Lumen Catheter BOTH IP/OP $420.00 $310.80 $0.00 $336.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $311.72 $311.72 $323.74 $0.00 $87.53 $0.00 $0.00 $0.00 $0.00 $210.00 $332.64 $336.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000250 EAP Custom 27000250 Tray Foley Preconnected W BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $0.00 $0.00 $0.00 $9.50 $15.05 $15.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000251 EAP Custom 27000251 Tray Foley Preconnected 1 BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000252 EAP Custom 27000252 Tray Foley Perconnected 1 BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000253 EAP Custom 27000253 Tray Thoracentesis/parace BOTH IP/OP $67.00 $49.58 $0.00 $53.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $49.73 $49.73 $51.64 $0.00 $13.96 $0.00 $0.00 $0.00 $0.00 $33.50 $53.06 $53.60 $0.00 $43.55 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000254 EAP Custom 27000254 Central Line Dressing Tray With Biopatch BOTH IP/OP $47.00 $34.78 $0.00 $37.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $34.88 $34.88 $36.23 $0.00 $9.79 $0.00 $0.00 $0.00 $0.00 $23.50 $37.22 $37.60 $0.00 $30.55 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000259 EAP Custom 27000259 "Suture, Silk, 0" BOTH IP/OP $15.00 $11.10 $0.00 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.13 $11.13 $11.56 $0.00 $3.13 $0.00 $0.00 $0.00 $0.00 $7.50 $11.88 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000265 EAP Custom 27000265 Sleeve Knee Regular Dvt BOTH IP/OP $388.00 $287.12 $0.00 $310.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $287.97 $287.97 $299.07 $0.00 $80.86 $0.00 $0.00 $0.00 $0.00 $194.00 $307.30 $310.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000266 EAP Custom 27000266 Sleeve Knee X-large Dvt BOTH IP/OP $469.00 $347.06 $0.00 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $348.09 $348.09 $361.51 $0.00 $97.74 $0.00 $0.00 $0.00 $0.00 $234.50 $371.45 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000267 EAP Custom 27000267 Sleeve Thigh Regular Dvt BOTH IP/OP $553.00 $409.22 $0.00 $442.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $410.44 $410.44 $426.25 $0.00 $115.25 $0.00 $0.00 $0.00 $0.00 $276.50 $437.98 $442.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000268 EAP Custom 27000268 Sleeve Thigh X-large Dvt BOTH IP/OP $284.00 $210.16 $0.00 $227.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $210.78 $210.78 $218.91 $0.00 $59.19 $0.00 $0.00 $0.00 $0.00 $142.00 $224.93 $227.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000293 EAP Custom 27000293 Catheter Urethral Two-eye BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000294 EAP HCPCS C1729 Catheter Coude Size 14fr BOTH IP/OP $109.00 $80.66 $0.00 $87.20 $59.19 $59.19 $0.00 $0.00 $0.00 $22.72 $80.90 $80.90 $84.02 $0.00 $22.72 $0.00 $64.47 $64.47 $0.00 $54.50 $86.33 $87.20 $0.00 $0.00 $0.00 $17.06 $0.00 $0.00 $17.35 $0.00 $0.00 $0.00 $0.00 $0.00 27000295 EAP HCPCS C1729 Catheter Coude 30cc 24fr BOTH IP/OP $87.00 $64.38 $0.00 $69.60 $47.24 $47.24 $0.00 $0.00 $0.00 $18.13 $64.57 $64.57 $67.06 $0.00 $18.13 $0.00 $51.46 $51.46 $0.00 $43.50 $68.90 $69.60 $0.00 $0.00 $0.00 $13.62 $0.00 $0.00 $13.85 $0.00 $0.00 $0.00 $0.00 $0.00 27000296 EAP Custom 27000296 Tube Salem Silicone Size BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000297 EAP Custom 27000297 Tubes Salem Sump 48 Leng BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000298 EAP Custom 27000298 Kit Tracheotomy Care Ster BOTH IP/OP $61.00 $45.14 $0.00 $48.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $45.27 $45.27 $47.02 $0.00 $12.71 $0.00 $0.00 $0.00 $0.00 $30.50 $48.31 $48.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000300 EAP Custom 27000300 Scapel Surg W/handle Atta BOTH IP/OP $142.00 $105.08 $0.00 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $105.39 $105.39 $109.45 $0.00 $29.59 $0.00 $0.00 $0.00 $0.00 $71.00 $112.46 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000314 EAP Custom 27000314 Bag 1000ml Pump Set BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000315 EAP Custom 27000315 Chest Unit Drainage Pleur BOTH IP/OP $455.00 $336.70 $0.00 $364.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $337.70 $337.70 $350.71 $0.00 $94.82 $0.00 $0.00 $0.00 $0.00 $227.50 $360.36 $364.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000318 EAP Custom 27000318 Tube Feeding Ng 8fr 36in Entr BOTH IP/OP $65.00 $48.10 $0.00 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $48.24 $48.24 $50.10 $0.00 $13.55 $0.00 $0.00 $0.00 $0.00 $32.50 $51.48 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000319 EAP Custom 27000319 Kit Triple Lumen Catheter BOTH IP/OP $697.00 $515.78 $0.00 $557.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $517.31 $517.31 $537.25 $0.00 $145.25 $0.00 $0.00 $0.00 $0.00 $348.50 $552.02 $557.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000323 EAP Custom 27000323 Vest Econo Cotton X-large BOTH IP/OP $102.00 $75.48 $0.00 $81.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $75.70 $75.70 $78.62 $0.00 $21.26 $0.00 $0.00 $0.00 $0.00 $51.00 $80.78 $81.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000324 EAP Custom 27000324 Filter Set 0.22 Micron BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $0.00 $0.00 $0.00 $9.50 $15.05 $15.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000326 EAP Custom 27000326 Tray Foley Preconnected 1 BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000327 EAP Custom 27000327 Tray Foley Perconnected 1 BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000330 EAP Custom 27000330 Central Line Dressing Tray With Biopatch BOTH IP/OP $47.00 $34.78 $0.00 $37.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $34.88 $34.88 $36.23 $0.00 $9.79 $0.00 $0.00 $0.00 $0.00 $23.50 $37.22 $37.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000335 EAP Custom 27000335 "Suture, Silk, 0" BOTH IP/OP $15.00 $11.10 $0.00 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.13 $11.13 $11.56 $0.00 $3.13 $0.00 $0.00 $0.00 $0.00 $7.50 $11.88 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000341 EAP Custom 27000341 Sleeve Knee Regular Dvt BOTH IP/OP $388.00 $287.12 $0.00 $310.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $287.97 $287.97 $299.07 $0.00 $80.86 $0.00 $0.00 $0.00 $0.00 $194.00 $307.30 $310.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000342 EAP Custom 27000342 Sleeve Knee X-large Dvt BOTH IP/OP $469.00 $347.06 $0.00 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $348.09 $348.09 $361.51 $0.00 $97.74 $0.00 $0.00 $0.00 $0.00 $234.50 $371.45 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000343 EAP Custom 27000343 Sleeve Thigh Regular Dvt BOTH IP/OP $553.00 $409.22 $0.00 $442.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $410.44 $410.44 $426.25 $0.00 $115.25 $0.00 $0.00 $0.00 $0.00 $276.50 $437.98 $442.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000344 EAP Custom 27000344 Sleeve Thigh X-large Dvt BOTH IP/OP $284.00 $210.16 $0.00 $227.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $210.78 $210.78 $218.91 $0.00 $59.19 $0.00 $0.00 $0.00 $0.00 $142.00 $224.93 $227.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000345 EAP Custom 27000345 Tubes Extension Plain Pla BOTH IP/OP $16.00 $11.84 $0.00 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.88 $11.88 $12.33 $0.00 $3.33 $0.00 $0.00 $0.00 $0.00 $8.00 $12.67 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000358 EAP Custom 27000358 Catheter Thoracic 16f BOTH IP/OP $40.00 $29.60 $0.00 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $20.00 $31.68 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000359 EAP Custom 27000359 Catheter Thoracic 20fr BOTH IP/OP $40.00 $29.60 $0.00 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $20.00 $31.68 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000360 EAP Custom 27000360 Catheter Thoracic 36fr BOTH IP/OP $43.00 $31.82 $0.00 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $31.91 $31.91 $33.14 $0.00 $8.96 $0.00 $0.00 $0.00 $0.00 $21.50 $34.06 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000361 EAP Custom 27000361 Catheter Ventricular 20cm BOTH IP/OP $735.00 $543.90 $0.00 $588.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $545.52 $545.52 $566.54 $0.00 $153.17 $0.00 $0.00 $0.00 $0.00 $367.50 $582.12 $588.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000362 EAP Custom 27000362 Catheter Edm 11 Becker BOTH IP/OP "$1,339.00 " $990.86 $0.00 "$1,071.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $993.81 $993.81 "$1,032.10" $0.00 $279.05 $0.00 $0.00 $0.00 $0.00 $669.50 "$1,060.49" "$1,071.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000363 EAP Custom 27000363 Tube Feeding Plastic 8fr BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000364 EAP Custom 27000364 Artery Arterial Catheriza BOTH IP/OP $42.00 $31.08 $0.00 $33.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $31.17 $31.17 $32.37 $0.00 $8.75 $0.00 $0.00 $0.00 $0.00 $21.00 $33.26 $33.60 $0.00 $27.30 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000365 EAP Custom 27000365 Artery Radial Catherizati BOTH IP/OP $69.00 $51.06 $0.00 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $51.21 $51.21 $53.19 $0.00 $14.38 $0.00 $0.00 $0.00 $0.00 $34.50 $54.65 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000366 EAP Custom 27000366 Tube Salem Sump 48 Lengt BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000367 EAP Custom 27000367 Tube Salem Silicone Size BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000368 EAP Custom 27000368 Tubes Salem Sump 48 Leng BOTH IP/OP $16.00 $11.84 $0.00 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.88 $11.88 $12.33 $0.00 $3.33 $0.00 $0.00 $0.00 $0.00 $8.00 $12.67 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000369 EAP Custom 27000369 Kit Tracheotomy Care Ster BOTH IP/OP $61.00 $45.14 $0.00 $48.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $45.27 $45.27 $47.02 $0.00 $12.71 $0.00 $0.00 $0.00 $0.00 $30.50 $48.31 $48.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000371 EAP Custom 27000371 Bag Drainage Becker BOTH IP/OP $197.00 $145.78 $0.00 $157.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $146.21 $146.21 $151.85 $0.00 $41.05 $0.00 $0.00 $0.00 $0.00 $98.50 $156.02 $157.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000372 EAP Custom 27000372 Tray Catheter Insrtn Dulm BOTH IP/OP $377.00 $278.98 $0.00 $301.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $279.81 $279.81 $290.59 $0.00 $78.57 $0.00 $0.00 $0.00 $0.00 $188.50 $298.58 $301.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000373 EAP Custom 27000373 Scapel Surg W/handle Atta BOTH IP/OP $142.00 $105.08 $0.00 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $105.39 $105.39 $109.45 $0.00 $29.59 $0.00 $0.00 $0.00 $0.00 $71.00 $112.46 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000374 EAP Custom 27000374 Scaple Surg W/handle Atta BOTH IP/OP $152.00 $112.48 $0.00 $121.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $112.81 $112.81 $117.16 $0.00 $31.68 $0.00 $0.00 $0.00 $0.00 $76.00 $120.38 $121.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000376 EAP Custom 27000376 Set Blood Administration BOTH IP/OP $34.00 $25.16 $0.00 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $25.23 $25.23 $26.21 $0.00 $7.09 $0.00 $0.00 $0.00 $0.00 $17.00 $26.93 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000378 EAP Custom 27000378 Cream Baza 5oz BOTH IP/OP $26.00 $19.24 $0.00 $20.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $19.30 $19.30 $20.04 $0.00 $5.42 $0.00 $0.00 $0.00 $0.00 $13.00 $20.59 $20.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000386 EAP Custom 27000386 Pouch Fecal Incontinence BOTH IP/OP $21.00 $15.54 $0.00 $16.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $15.59 $15.59 $16.19 $0.00 $4.38 $0.00 $0.00 $0.00 $0.00 $10.50 $16.63 $16.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000387 EAP Custom 27000387 Kit Pressure Monitoring T BOTH IP/OP $177.00 $130.98 $0.00 $141.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $131.37 $131.37 $136.43 $0.00 $36.89 $0.00 $0.00 $0.00 $0.00 $88.50 $140.18 $141.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000388 EAP Custom 27000388 Transducer Disp For Icp BOTH IP/OP $36.00 $26.64 $0.00 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $26.72 $26.72 $27.75 $0.00 $7.50 $0.00 $0.00 $0.00 $0.00 $18.00 $28.51 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000389 EAP Custom 27000389 Bridge Kit Bifurated Resp BOTH IP/OP $131.00 $96.94 $0.00 $104.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $97.23 $97.23 $100.97 $0.00 $27.30 $0.00 $0.00 $0.00 $0.00 $65.50 $103.75 $104.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000390 EAP Custom 27000390 Kit Transducer Monitoring BOTH IP/OP $339.00 $250.86 $0.00 $271.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $251.61 $251.61 $261.30 $0.00 $70.65 $0.00 $0.00 $0.00 $0.00 $169.50 $268.49 $271.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000392 EAP Custom 27000392 Kit Pressure Monitoring BOTH IP/OP $250.00 $185.00 $0.00 $200.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $185.55 $185.55 $192.70 $0.00 $52.10 $0.00 $0.00 $0.00 $0.00 $125.00 $198.00 $200.00 $0.00 $162.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000394 EAP Custom 27000394 Bag 1000ml Pump Set BOTH IP/OP $34.00 $25.16 $0.00 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $25.23 $25.23 $26.21 $0.00 $7.09 $0.00 $0.00 $0.00 $0.00 $17.00 $26.93 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000395 EAP Custom 27000395 Kit Pecutaneous Introduce BOTH IP/OP $101.00 $74.74 $0.00 $80.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $74.96 $74.96 $77.85 $0.00 $21.05 $0.00 $0.00 $0.00 $0.00 $50.50 $79.99 $80.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000396 EAP Custom 27000396 Chest Unit Drainage Pleur BOTH IP/OP $455.00 $336.70 $0.00 $364.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $337.70 $337.70 $350.71 $0.00 $94.82 $0.00 $0.00 $0.00 $0.00 $227.50 $360.36 $364.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000403 EAP Custom 27000403 Tube Feeding Ng 8fr 36in Entr BOTH IP/OP $61.00 $45.14 $0.00 $48.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $45.27 $45.27 $47.02 $0.00 $12.71 $0.00 $0.00 $0.00 $0.00 $30.50 $48.31 $48.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000404 EAP Custom 27000404 Kit Triple Lumen Catheter BOTH IP/OP $299.00 $221.26 $0.00 $239.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $221.92 $221.92 $230.47 $0.00 $62.31 $0.00 $0.00 $0.00 $0.00 $149.50 $236.81 $239.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000405 EAP Custom 27000405 Catheter Swan Ganz BOTH IP/OP $674.00 $498.76 $0.00 $539.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $500.24 $500.24 $519.52 $0.00 $140.46 $0.00 $0.00 $0.00 $0.00 $337.00 $533.81 $539.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000406 EAP Custom 27000406 Delivery System Closed In BOTH IP/OP $65.00 $48.10 $0.00 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $48.24 $48.24 $50.10 $0.00 $13.55 $0.00 $0.00 $0.00 $0.00 $32.50 $51.48 $52.00 $0.00 $42.25 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000407 EAP Custom 27000407 Probe V-pacing BOTH IP/OP "$1,403.00 " "$1,038.22" $0.00 "$1,122.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,041.31" "$1,041.31" "$1,081.43" $0.00 $292.39 $0.00 $0.00 $0.00 $0.00 $701.50 "$1,111.18" "$1,122.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000410 EAP Custom 27000410 Filter Set 0.22 Micron BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $0.00 $0.00 $0.00 $9.50 $15.05 $15.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000412 EAP Custom 27000412 Kit Ventriculostomy BOTH IP/OP "$1,652.00 " "$1,222.48" $0.00 "$1,321.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,226.11" "$1,226.11" "$1,273.36" $0.00 $344.28 $0.00 $0.00 $0.00 $0.00 $826.00 "$1,308.38" "$1,321.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000414 EAP Custom 27000414 "Suture, Silk, 0" BOTH IP/OP $15.00 $11.10 $0.00 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.13 $11.13 $11.56 $0.00 $3.13 $0.00 $0.00 $0.00 $0.00 $7.50 $11.88 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000454 EAP Custom 27000454 Catheter Thoracic 28fr BOTH IP/OP $40.00 $29.60 $0.00 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $20.00 $31.68 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000455 EAP Custom 27000455 Catheter Thoracic 32fr BOTH IP/OP $40.00 $29.60 $0.00 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $29.69 $29.69 $30.83 $0.00 $8.34 $0.00 $0.00 $0.00 $0.00 $20.00 $31.68 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000456 EAP Custom 27000456 Catheter Thoracic 36fr BOTH IP/OP $40.00 $29.60 $0.00 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $29.69 $29.69 $30.83 $0.00 $8.34 $0.00 $0.00 $0.00 $0.00 $20.00 $31.68 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000457 EAP Custom 27000457 Catheter Urethral 14fr BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000458 EAP Custom 27000458 Catheter Urethral Two-eye BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000459 EAP Custom 27000459 Tube Salem Sump 48 Lengt BOTH IP/OP $36.00 $26.64 $0.00 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $26.72 $26.72 $27.75 $0.00 $7.50 $0.00 $0.00 $0.00 $0.00 $18.00 $28.51 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000460 EAP Custom 27000460 Tube Salem Silicone Size BOTH IP/OP $28.00 $20.72 $0.00 $22.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $20.78 $20.78 $21.58 $0.00 $5.84 $0.00 $0.00 $0.00 $0.00 $14.00 $22.18 $22.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000461 EAP Custom 27000461 Tubes Salem Sump 48 Leng BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000462 EAP Custom 27000462 Kit Tracheotomy Care Ster BOTH IP/OP $61.00 $45.14 $0.00 $48.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $45.27 $45.27 $47.02 $0.00 $12.71 $0.00 $0.00 $0.00 $0.00 $30.50 $48.31 $48.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000464 EAP Custom 27000464 Scaple Surg W/handle Atta BOTH IP/OP $152.00 $112.48 $0.00 $121.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $112.81 $112.81 $117.16 $0.00 $31.68 $0.00 $0.00 $0.00 $0.00 $76.00 $120.38 $121.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000474 EAP Custom 27000474 Bag 1000ml Pump Set BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000475 EAP Custom 27000475 Needle Port-cath 20ga X 1 BOTH IP/OP $34.00 $25.16 $0.00 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $25.23 $25.23 $26.21 $0.00 $7.09 $0.00 $0.00 $0.00 $0.00 $17.00 $26.93 $27.20 $0.00 $22.10 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000476 EAP Custom 27000476 Chest Unit Drainage Pleur BOTH IP/OP $195.00 $144.30 $0.00 $156.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $144.73 $144.73 $150.31 $0.00 $40.64 $0.00 $0.00 $0.00 $0.00 $97.50 $154.44 $156.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000481 EAP Custom 27000481 Tube Feeding Ng 8fr 36in Entr BOTH IP/OP $30.00 $22.20 $0.00 $24.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $22.27 $22.27 $23.12 $0.00 $6.25 $0.00 $0.00 $0.00 $0.00 $15.00 $23.76 $24.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000482 EAP Custom 27000482 Kit Triple Lumen Catheter BOTH IP/OP $299.00 $221.26 $0.00 $239.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $221.92 $221.92 $230.47 $0.00 $62.31 $0.00 $0.00 $0.00 $0.00 $149.50 $236.81 $239.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000483 EAP Custom 27000483 Filter Set 0.22 Micron BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $0.00 $0.00 $0.00 $9.50 $15.05 $15.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000484 EAP Custom 27000484 Tray Catheter Urethral 14 BOTH IP/OP $17.00 $12.58 $0.00 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $12.62 $12.62 $13.10 $0.00 $3.54 $0.00 $0.00 $0.00 $0.00 $8.50 $13.46 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000487 EAP Custom 27000487 Tray Foley Preconnected 1 BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000488 EAP Custom 27000488 Tray Foley Perconnected 1 BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000489 EAP Custom 27000489 Tray Thoracentesis Dispos BOTH IP/OP $235.00 $173.90 $0.00 $188.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $174.42 $174.42 $181.14 $0.00 $48.97 $0.00 $0.00 $0.00 $0.00 $117.50 $186.12 $188.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000491 EAP Custom 27000491 Central Line Dressing Tray With Biopatch BOTH IP/OP $47.00 $34.78 $0.00 $37.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $34.88 $34.88 $36.23 $0.00 $9.79 $0.00 $0.00 $0.00 $0.00 $23.50 $37.22 $37.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000495 EAP Custom 27000495 "Suture, Silk, 0" BOTH IP/OP $15.00 $11.10 $0.00 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.13 $11.13 $11.56 $0.00 $3.13 $0.00 $0.00 $0.00 $0.00 $7.50 $11.88 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000501 EAP Custom 27000501 Sleeve Knee Regular Dvt BOTH IP/OP $388.00 $287.12 $0.00 $310.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $287.97 $287.97 $299.07 $0.00 $80.86 $0.00 $0.00 $0.00 $0.00 $194.00 $307.30 $310.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000502 EAP Custom 27000502 Sleeve Knee X-large Dvt BOTH IP/OP $469.00 $347.06 $0.00 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $348.09 $348.09 $361.51 $0.00 $97.74 $0.00 $0.00 $0.00 $0.00 $234.50 $371.45 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000503 EAP Custom 27000503 Sleeve Thigh Regular Dvt BOTH IP/OP $228.00 $168.72 $0.00 $182.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $169.22 $169.22 $175.74 $0.00 $47.52 $0.00 $0.00 $0.00 $0.00 $114.00 $180.58 $182.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000504 EAP Custom 27000504 Sleeve Thigh X-large Dvt BOTH IP/OP $616.00 $455.84 $0.00 $492.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $457.20 $457.20 $474.81 $0.00 $128.37 $0.00 $0.00 $0.00 $0.00 $308.00 $487.87 $492.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000530 EAP Custom 27000530 Catheter Thoracic 28fr BOTH IP/OP $43.00 $31.82 $0.00 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $21.50 $34.06 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000531 EAP Custom 27000531 Catheter Thoracic 32fr BOTH IP/OP $43.00 $31.82 $0.00 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $31.91 $31.91 $33.14 $0.00 $8.96 $0.00 $0.00 $0.00 $0.00 $21.50 $34.06 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000532 EAP Custom 27000532 Catheter Thoracic 36fr BOTH IP/OP $43.00 $31.82 $0.00 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $31.91 $31.91 $33.14 $0.00 $8.96 $0.00 $0.00 $0.00 $0.00 $21.50 $34.06 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000533 EAP Custom 27000533 Tube Salem Sump 48 Lengt BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000534 EAP Custom 27000534 Tubes Salem Sump 48 Leng BOTH IP/OP $16.00 $11.84 $0.00 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.88 $11.88 $12.33 $0.00 $3.33 $0.00 $0.00 $0.00 $0.00 $8.00 $12.67 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000535 EAP Custom 27000535 Kit Tracheotomy Care Ster BOTH IP/OP $65.00 $48.10 $0.00 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $48.24 $48.24 $50.10 $0.00 $13.55 $0.00 $0.00 $0.00 $0.00 $32.50 $51.48 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000538 EAP Custom 27000538 Scapel Surg W/ Handle Atta BOTH IP/OP $142.00 $105.08 $0.00 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $105.39 $105.39 $109.45 $0.00 $29.59 $0.00 $0.00 $0.00 $0.00 $71.00 $112.46 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000543 EAP Custom 27000543 Kit Thoracotomy BOTH IP/OP $36.00 $26.64 $0.00 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $26.72 $26.72 $27.75 $0.00 $7.50 $0.00 $0.00 $0.00 $0.00 $18.00 $28.51 $28.80 $0.00 $23.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000549 EAP Custom 27000549 Bag 1000ml Pump Set BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000551 EAP Custom 27000551 Chest Unit Drainage Pleur BOTH IP/OP $69.00 $51.06 $0.00 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $51.21 $51.21 $53.19 $0.00 $14.38 $0.00 $0.00 $0.00 $0.00 $34.50 $54.65 $55.20 $0.00 $44.85 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000556 EAP Custom 27000556 Tube Feeding Ng 8fr 36in Entr BOTH IP/OP $30.00 $22.20 $0.00 $24.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $22.27 $22.27 $23.12 $0.00 $6.25 $0.00 $0.00 $0.00 $0.00 $15.00 $23.76 $24.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000557 EAP Custom 27000557 Kit Triple Lumen Catheter BOTH IP/OP $299.00 $221.26 $0.00 $239.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $221.92 $221.92 $230.47 $0.00 $62.31 $0.00 $0.00 $0.00 $0.00 $149.50 $236.81 $239.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000558 EAP Custom 27000558 Filter Set 0.22 Micron BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $0.00 $0.00 $0.00 $9.50 $15.05 $15.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000559 EAP Custom 27000559 Tray Catheter Urethral 14 BOTH IP/OP $17.00 $12.58 $0.00 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $12.62 $12.62 $13.10 $0.00 $3.54 $0.00 $0.00 $0.00 $0.00 $8.50 $13.46 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000560 EAP Custom 27000560 Tray Douch Disposable BOTH IP/OP $69.00 $51.06 $0.00 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $51.21 $51.21 $53.19 $0.00 $14.38 $0.00 $0.00 $0.00 $0.00 $34.50 $54.65 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000562 EAP Custom 27000562 Tray Foley Preconnected 1 BOTH IP/OP $22.00 $16.28 $0.00 $17.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $16.33 $16.33 $16.96 $0.00 $4.58 $0.00 $0.00 $0.00 $0.00 $11.00 $17.42 $17.60 $0.00 $14.30 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000563 EAP Custom 27000563 Tray Foley Perconnected 1 BOTH IP/OP $22.00 $16.28 $0.00 $17.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $16.33 $16.33 $16.96 $0.00 $4.58 $0.00 $0.00 $0.00 $0.00 $11.00 $17.42 $17.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000564 EAP Custom 27000564 Tray Thoracentesis Dispos BOTH IP/OP $261.00 $193.14 $0.00 $208.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $193.71 $193.71 $201.18 $0.00 $54.39 $0.00 $0.00 $0.00 $0.00 $130.50 $206.71 $208.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000570 EAP Custom 27000570 "Suture, Silk, 0" BOTH IP/OP $15.00 $11.10 $0.00 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.13 $11.13 $11.56 $0.00 $3.13 $0.00 $0.00 $0.00 $0.00 $7.50 $11.88 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000577 EAP Custom 27000577 Sleeve Knee Regular Dvt BOTH IP/OP $388.00 $287.12 $0.00 $310.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $287.97 $287.97 $299.07 $0.00 $80.86 $0.00 $0.00 $0.00 $0.00 $194.00 $307.30 $310.40 $0.00 $252.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000578 EAP Custom 27000578 Sleeve Knee X-large Dvt BOTH IP/OP $469.00 $347.06 $0.00 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $348.09 $348.09 $361.51 $0.00 $97.74 $0.00 $0.00 $0.00 $0.00 $234.50 $371.45 $375.20 $0.00 $304.85 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000579 EAP Custom 27000579 Sleeve Thigh Regular Dvt BOTH IP/OP $238.00 $176.12 $0.00 $190.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $176.64 $176.64 $183.45 $0.00 $49.60 $0.00 $0.00 $0.00 $0.00 $119.00 $188.50 $190.40 $0.00 $154.70 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000580 EAP Custom 27000580 Sleeve Thigh X-large Dvt BOTH IP/OP $616.00 $455.84 $0.00 $492.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $457.20 $457.20 $474.81 $0.00 $128.37 $0.00 $0.00 $0.00 $0.00 $308.00 $487.87 $492.80 $0.00 $400.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000604 EAP Custom 27000604 Catheter Thoracic 28fr BOTH IP/OP $40.00 $29.60 $0.00 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $20.00 $31.68 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000605 EAP Custom 27000605 Catheter Thoracic 32fr BOTH IP/OP $18.00 $13.32 $0.00 $14.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $13.36 $13.36 $13.87 $0.00 $3.75 $0.00 $0.00 $0.00 $0.00 $9.00 $14.26 $14.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000606 EAP Custom 27000606 Catheter Thoracic 36fr BOTH IP/OP $18.00 $13.32 $0.00 $14.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $13.36 $13.36 $13.87 $0.00 $3.75 $0.00 $0.00 $0.00 $0.00 $9.00 $14.26 $14.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000607 EAP Custom 27000607 Tube Salem Sump 48 Lengt BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000608 EAP Custom 27000608 Tubes Salem Sump 48 Leng BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000612 EAP Custom 27000612 Scapel Surg W/handle Atta BOTH IP/OP $142.00 $105.08 $0.00 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $105.39 $105.39 $109.45 $0.00 $29.59 $0.00 $0.00 $0.00 $0.00 $71.00 $112.46 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000613 EAP Custom 27000613 Scaple Surg W/handle Atta BOTH IP/OP $152.00 $112.48 $0.00 $121.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $112.81 $112.81 $117.16 $0.00 $31.68 $0.00 $0.00 $0.00 $0.00 $76.00 $120.38 $121.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000618 EAP Custom 27000618 Kit Thoracotomy BOTH IP/OP $93.00 $68.82 $0.00 $74.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $69.02 $69.02 $71.68 $0.00 $19.38 $0.00 $0.00 $0.00 $0.00 $46.50 $73.66 $74.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000624 EAP Custom 27000624 Bag 1000ml Pump Set BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000625 EAP Custom 27000625 Chest Unit Drainage Pleur BOTH IP/OP $332.00 $245.68 $0.00 $265.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $246.41 $246.41 $255.91 $0.00 $69.19 $0.00 $0.00 $0.00 $0.00 $166.00 $262.94 $265.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000630 EAP Custom 27000630 Dressing X-large BOTH IP/OP $697.00 $515.78 $0.00 $557.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $517.31 $517.31 $537.25 $0.00 $145.25 $0.00 $0.00 $0.00 $0.00 $348.50 $552.02 $557.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000632 EAP Custom 27000632 Tube Feeding Ng 8fr 36in Entr BOTH IP/OP $30.00 $22.20 $0.00 $24.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $22.27 $22.27 $23.12 $0.00 $6.25 $0.00 $0.00 $0.00 $0.00 $15.00 $23.76 $24.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000633 EAP Custom 27000633 Kit Triple Lumen Catheter BOTH IP/OP $299.00 $221.26 $0.00 $239.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $221.92 $221.92 $230.47 $0.00 $62.31 $0.00 $0.00 $0.00 $0.00 $149.50 $236.81 $239.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000637 EAP Custom 27000637 Tray Catheter Urethral 14 BOTH IP/OP $17.00 $12.58 $0.00 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $12.62 $12.62 $13.10 $0.00 $3.54 $0.00 $0.00 $0.00 $0.00 $8.50 $13.46 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000638 EAP Custom 27000638 Tray Douch Disposable BOTH IP/OP $69.00 $51.06 $0.00 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $51.21 $51.21 $53.19 $0.00 $14.38 $0.00 $0.00 $0.00 $0.00 $34.50 $54.65 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000640 EAP Custom 27000640 Tray Foley Preconnected 1 BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000641 EAP Custom 27000641 Tray Foley Perconnected 1 BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000642 EAP Custom 27000642 Tray Thoracentesis Dispos BOTH IP/OP $235.00 $173.90 $0.00 $188.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $174.42 $174.42 $181.14 $0.00 $48.97 $0.00 $0.00 $0.00 $0.00 $117.50 $186.12 $188.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000648 EAP Custom 27000648 "Suture, Silk, 0" BOTH IP/OP $15.00 $11.10 $0.00 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.13 $11.13 $11.56 $0.00 $3.13 $0.00 $0.00 $0.00 $0.00 $7.50 $11.88 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000653 EAP Custom 27000653 Sleeve Knee Regular Dvt BOTH IP/OP $388.00 $287.12 $0.00 $310.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $287.97 $287.97 $299.07 $0.00 $80.86 $0.00 $0.00 $0.00 $0.00 $194.00 $307.30 $310.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000654 EAP Custom 27000654 Sleeve Knee X-large Dvt BOTH IP/OP $469.00 $347.06 $0.00 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $348.09 $348.09 $361.51 $0.00 $97.74 $0.00 $0.00 $0.00 $0.00 $234.50 $371.45 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000655 EAP Custom 27000655 Sleeve Thigh Regular Dvt BOTH IP/OP $553.00 $409.22 $0.00 $442.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $410.44 $410.44 $426.25 $0.00 $115.25 $0.00 $0.00 $0.00 $0.00 $276.50 $437.98 $442.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000656 EAP Custom 27000656 Sleeve Thigh X-large Dvt BOTH IP/OP $663.00 $490.62 $0.00 $530.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $492.08 $492.08 $511.04 $0.00 $138.17 $0.00 $0.00 $0.00 $0.00 $331.50 $525.10 $530.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000666 EAP Custom 27000666 Tube Salem Sump 48 Lengt BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000667 EAP Custom 27000667 Scapel Surg W/handle Atta BOTH IP/OP $142.00 $105.08 $0.00 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $105.39 $105.39 $109.45 $0.00 $29.59 $0.00 $0.00 $0.00 $0.00 $71.00 $112.46 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000679 EAP Custom 27000679 Kit Triple Lumen Catheter BOTH IP/OP $646.00 $478.04 $0.00 $516.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $479.46 $479.46 $497.94 $0.00 $134.63 $0.00 $0.00 $0.00 $0.00 $323.00 $511.63 $516.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000680 EAP Custom 27000680 Filter Set 0.22 Micron BOTH IP/OP $7.00 $5.18 $0.00 $5.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $5.20 $5.20 $5.40 $0.00 $1.46 $0.00 $0.00 $0.00 $0.00 $3.50 $5.54 $5.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000683 EAP Custom 27000683 Tray Catheter Urethral 14 BOTH IP/OP $17.00 $12.58 $0.00 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $12.62 $12.62 $13.10 $0.00 $3.54 $0.00 $0.00 $0.00 $0.00 $8.50 $13.46 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000686 EAP Custom 27000686 Tray Foley Preconnected 1 BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000687 EAP Custom 27000687 Tray Foley Perconnected 1 BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000689 EAP Custom 27000689 Tray Thoracentesis Dispos BOTH IP/OP $216.00 $159.84 $0.00 $172.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $160.32 $160.32 $166.49 $0.00 $45.01 $0.00 $0.00 $0.00 $0.00 $108.00 $171.07 $172.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000691 EAP Custom 27000691 Bag Drainage Ureteral BOTH IP/OP $92.00 $68.08 $0.00 $73.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $68.28 $68.28 $70.91 $0.00 $19.17 $0.00 $0.00 $0.00 $0.00 $46.00 $72.86 $73.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000696 EAP Custom 27000696 "Suture, Silk, 0" BOTH IP/OP $15.00 $11.10 $0.00 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.13 $11.13 $11.56 $0.00 $3.13 $0.00 $0.00 $0.00 $0.00 $7.50 $11.88 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000697 EAP Custom 27000697 10ml Posiflush Saline Syringe BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $6.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000701 EAP Custom 27000701 Sleeve Knee Regular Dvt BOTH IP/OP $378.00 $279.72 $0.00 $302.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $280.55 $280.55 $291.36 $0.00 $78.78 $0.00 $0.00 $0.00 $0.00 $189.00 $299.38 $302.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000702 EAP Custom 27000702 Sleeve Knee X-large Dvt BOTH IP/OP $469.00 $347.06 $0.00 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $348.09 $348.09 $361.51 $0.00 $97.74 $0.00 $0.00 $0.00 $0.00 $234.50 $371.45 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000703 EAP Custom 27000703 Sleeve Thigh Regular Dvt BOTH IP/OP $553.00 $409.22 $0.00 $442.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $410.44 $410.44 $426.25 $0.00 $115.25 $0.00 $0.00 $0.00 $0.00 $276.50 $437.98 $442.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000704 EAP Custom 27000704 Sleeve Thigh X-large Dvt BOTH IP/OP $284.00 $210.16 $0.00 $227.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $210.78 $210.78 $218.91 $0.00 $59.19 $0.00 $0.00 $0.00 $0.00 $142.00 $224.93 $227.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000705 EAP Custom 27000705 Sucrose Analgesia BOTH IP/OP $15.00 $11.10 $0.00 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.13 $11.13 $11.56 $0.00 $3.13 $0.00 $0.00 $0.00 $0.00 $7.50 $11.88 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000709 EAP Custom 27000709 Tray Circumcision BOTH IP/OP $47.00 $34.78 $0.00 $37.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $34.88 $34.88 $36.23 $0.00 $9.79 $0.00 $0.00 $0.00 $0.00 $23.50 $37.22 $37.60 $0.00 $30.55 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000710 EAP Custom 27000710 Needle Spinal 22g 25/bx BOTH IP/OP $3.00 $2.22 $0.00 $2.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $1.50 $2.38 $2.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000712 EAP Custom 27000712 Tubes Capillary Hepariniz BOTH IP/OP $160.00 $118.40 $0.00 $128.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $118.75 $118.75 $123.33 $0.00 $33.34 $0.00 $0.00 $0.00 $0.00 $80.00 $126.72 $128.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000714 EAP Custom 27000714 Tube Feeding Plastic 8fr BOTH IP/OP $3.00 $2.22 $0.00 $2.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $2.23 $2.23 $2.31 $0.00 $0.63 $0.00 $0.00 $0.00 $0.00 $1.50 $2.38 $2.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000715 EAP Custom 27000715 Scapel Surg W/handle Atta BOTH IP/OP $142.00 $105.08 $0.00 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $105.39 $105.39 $109.45 $0.00 $29.59 $0.00 $0.00 $0.00 $0.00 $71.00 $112.46 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000721 EAP Custom 27000721 Tray Catheter Urethral 14 BOTH IP/OP $17.00 $12.58 $0.00 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $12.62 $12.62 $13.10 $0.00 $3.54 $0.00 $0.00 $0.00 $0.00 $8.50 $13.46 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000723 EAP Custom 27000723 Tray Foley Preconnected 1 BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000724 EAP Custom 27000724 Tray Foley Perconnected 1 BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000725 EAP HCPCS C1751 Catheter Iv 26g 120/cs BOTH IP/OP $28.00 $20.72 $0.00 $22.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.00 $22.18 $22.40 $0.00 $0.00 $0.00 $4.38 $0.00 $0.00 $4.46 $0.00 $0.00 $0.00 $0.00 $0.00 27000726 EAP Custom 27000726 Sleeve Knee Regular Dvt BOTH IP/OP $166.00 $122.84 $0.00 $132.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $123.21 $123.21 $127.95 $0.00 $34.59 $0.00 $0.00 $0.00 $0.00 $83.00 $131.47 $132.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000727 EAP Custom 27000727 Sleeve Knee X-large Dvt BOTH IP/OP $201.00 $148.74 $0.00 $160.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $149.18 $149.18 $154.93 $0.00 $41.89 $0.00 $0.00 $0.00 $0.00 $100.50 $159.19 $160.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000728 EAP Custom 27000728 Sleeve Thigh X-large Dvt BOTH IP/OP $284.00 $210.16 $0.00 $227.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $210.78 $210.78 $218.91 $0.00 $59.19 $0.00 $0.00 $0.00 $0.00 $142.00 $224.93 $227.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000741 EAP Custom 27000741 Catheter Thoracic 28fr BOTH IP/OP $40.00 $29.60 $0.00 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $20.00 $31.68 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000742 EAP Custom 27000742 Catheter Thoracic 32fr BOTH IP/OP $40.00 $29.60 $0.00 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $29.69 $29.69 $30.83 $0.00 $8.34 $0.00 $0.00 $0.00 $0.00 $20.00 $31.68 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000743 EAP Custom 27000743 Catheter Thoracic 36fr BOTH IP/OP $18.00 $13.32 $0.00 $14.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $13.36 $13.36 $13.87 $0.00 $3.75 $0.00 $0.00 $0.00 $0.00 $9.00 $14.26 $14.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000744 EAP Custom 27000744 Tube Salem Sump 48 Lengt BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000745 EAP Custom 27000745 Tubes Salem Sump 48 Leng BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000748 EAP Custom 27000748 Scapel Surg W/handle Att BOTH IP/OP $142.00 $105.08 $0.00 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $105.39 $105.39 $109.45 $0.00 $29.59 $0.00 $0.00 $0.00 $0.00 $71.00 $112.46 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000760 EAP Custom 27000760 Bag 1000ml Pump Set BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000762 EAP Custom 27000762 Chest Unit Drainage Pleur BOTH IP/OP $420.00 $310.80 $0.00 $336.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $311.72 $311.72 $323.74 $0.00 $87.53 $0.00 $0.00 $0.00 $0.00 $210.00 $332.64 $336.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000765 EAP Custom 27000765 Tube Feeding Ng 8fr 36in Entr BOTH IP/OP $65.00 $48.10 $0.00 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $48.24 $48.24 $50.10 $0.00 $13.55 $0.00 $0.00 $0.00 $0.00 $32.50 $51.48 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000766 EAP Custom 27000766 Kit Triple Lumen Catheter BOTH IP/OP $299.00 $221.26 $0.00 $239.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $221.92 $221.92 $230.47 $0.00 $62.31 $0.00 $0.00 $0.00 $0.00 $149.50 $236.81 $239.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000770 EAP Custom 27000770 Filter Set 0.22 Micron BOTH IP/OP $7.00 $5.18 $0.00 $5.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $5.20 $5.20 $5.40 $0.00 $1.46 $0.00 $0.00 $0.00 $0.00 $3.50 $5.54 $5.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000771 EAP Custom 27000771 Tray Catheter Urethral 14 BOTH IP/OP $17.00 $12.58 $0.00 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $12.62 $12.62 $13.10 $0.00 $3.54 $0.00 $0.00 $0.00 $0.00 $8.50 $13.46 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000772 EAP Custom 27000772 Tray Douch Disposable BOTH IP/OP $69.00 $51.06 $0.00 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $51.21 $51.21 $53.19 $0.00 $14.38 $0.00 $0.00 $0.00 $0.00 $34.50 $54.65 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000773 EAP Custom 27000773 Tray Foley Preconnected 1 BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000774 EAP Custom 27000774 Tray Foley Perconnected 1 BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000775 EAP Custom 27000775 Tray Thoracentesis Dispos BOTH IP/OP $235.00 $173.90 $0.00 $188.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $174.42 $174.42 $181.14 $0.00 $48.97 $0.00 $0.00 $0.00 $0.00 $117.50 $186.12 $188.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000776 EAP Custom 27000776 Central Line Dressing Tray With Biopatch BOTH IP/OP $47.00 $34.78 $0.00 $37.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $34.88 $34.88 $36.23 $0.00 $9.79 $0.00 $0.00 $0.00 $0.00 $23.50 $37.22 $37.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000781 EAP Custom 27000781 "Suture, Silk, 0" BOTH IP/OP $15.00 $11.10 $0.00 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.13 $11.13 $11.56 $0.00 $3.13 $0.00 $0.00 $0.00 $0.00 $7.50 $11.88 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000784 EAP Custom 27000784 3ml Posiflush Saline Syringe BOTH IP/OP $40.00 $29.60 $0.00 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $29.69 $29.69 $30.83 $0.00 $8.34 $0.00 $0.00 $0.00 $0.00 $20.00 $31.68 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000787 EAP Custom 27000787 Sleeve Knee Regular Dvt BOTH IP/OP $388.00 $287.12 $0.00 $310.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $287.97 $287.97 $299.07 $0.00 $80.86 $0.00 $0.00 $0.00 $0.00 $194.00 $307.30 $310.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000788 EAP Custom 27000788 Sleeve Knee X-ray Dvt BOTH IP/OP $469.00 $347.06 $0.00 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $348.09 $348.09 $361.51 $0.00 $97.74 $0.00 $0.00 $0.00 $0.00 $234.50 $371.45 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000789 EAP Custom 27000789 Sleeve Thigh Regular Dvt BOTH IP/OP $553.00 $409.22 $0.00 $442.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $410.44 $410.44 $426.25 $0.00 $115.25 $0.00 $0.00 $0.00 $0.00 $276.50 $437.98 $442.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000790 EAP Custom 27000790 Sleeve Thigh X-large Dvt BOTH IP/OP $284.00 $210.16 $0.00 $227.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $210.78 $210.78 $218.91 $0.00 $59.19 $0.00 $0.00 $0.00 $0.00 $142.00 $224.93 $227.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000791 EAP Custom 27000791 First Step Select Overlay BOTH IP/OP $131.00 $96.94 $0.00 $104.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $97.23 $97.23 $100.97 $0.00 $27.30 $0.00 $0.00 $0.00 $0.00 $65.50 $103.75 $104.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000792 EAP Custom 27000792 Telemetry Med Supplies BOTH IP/OP $150.00 $111.00 $0.00 $120.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $111.33 $111.33 $115.62 $0.00 $31.26 $0.00 $0.00 $0.00 $0.00 $75.00 $118.80 $120.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000793 EAP Custom 27000793 Med/surg Isolation Supplies BOTH IP/OP $281.00 $207.94 $0.00 $224.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $208.56 $208.56 $216.59 $0.00 $58.56 $0.00 $0.00 $0.00 $0.00 $140.50 $222.55 $224.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000803 EAP Custom 27000803 Dialysis Filter BOTH IP/OP $699.00 $517.26 $0.00 $559.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $518.80 $518.80 $538.79 $0.00 $145.67 $0.00 $0.00 $0.00 $0.00 $349.50 $553.61 $559.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000810 EAP Custom 27000810 Needle Spinal 18ga BOTH IP/OP $16.00 $11.84 $0.00 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.88 $11.88 $12.33 $0.00 $3.33 $0.00 $0.00 $0.00 $0.00 $8.00 $12.67 $12.80 $0.00 $10.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000811 EAP Custom 27000811 Needle Spinal Sterile 20g BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $6.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000815 EAP Custom 27000815 Catheter Thoracic 28fr BOTH IP/OP $43.00 $31.82 $0.00 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $21.50 $34.06 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000816 EAP Custom 27000816 Catheter Thoracic 32fr BOTH IP/OP $43.00 $31.82 $0.00 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $31.91 $31.91 $33.14 $0.00 $8.96 $0.00 $0.00 $0.00 $0.00 $21.50 $34.06 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000817 EAP Custom 27000817 Catheter Thoracic 36fr BOTH IP/OP $43.00 $31.82 $0.00 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $31.91 $31.91 $33.14 $0.00 $8.96 $0.00 $0.00 $0.00 $0.00 $21.50 $34.06 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000818 EAP HCPCS C1729 Catheter Foley 30cc 28fr BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $21.18 $21.18 $0.00 $0.00 $0.00 $8.13 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $23.07 $23.07 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $6.10 $0.00 $0.00 $6.21 $0.00 $0.00 $0.00 $0.00 $0.00 27000819 EAP Custom 27000819 Artery Arterial Catheriza BOTH IP/OP $109.00 $80.66 $0.00 $87.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $80.90 $80.90 $84.02 $0.00 $22.72 $0.00 $0.00 $0.00 $0.00 $54.50 $86.33 $87.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000820 EAP Custom 27000820 Artery Radial Catherizati BOTH IP/OP $69.00 $51.06 $0.00 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $34.50 $54.65 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000821 EAP Custom 27000821 Tube Salem Silicone Size BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000822 EAP Custom 27000822 Tubes Salem Sump 48 Leng BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000826 EAP Custom 27000826 Tray Catheter Insrtn Dulm BOTH IP/OP $434.00 $321.16 $0.00 $347.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $322.11 $322.11 $334.53 $0.00 $90.45 $0.00 $0.00 $0.00 $0.00 $217.00 $343.73 $347.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000828 EAP Custom 27000828 Catheter Peritoneal Adult BOTH IP/OP $210.00 $155.40 $0.00 $168.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $155.86 $155.86 $161.87 $0.00 $43.76 $0.00 $0.00 $0.00 $0.00 $105.00 $166.32 $168.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000829 EAP Custom 27000829 Triconnector With Valve BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000830 EAP Custom 27000830 Set Blood Administration BOTH IP/OP $34.00 $25.16 $0.00 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $25.23 $25.23 $26.21 $0.00 $7.09 $0.00 $0.00 $0.00 $0.00 $17.00 $26.93 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000834 EAP Custom 27000834 Kit L.f. Trach Care BOTH IP/OP $237.00 $175.38 $0.00 $189.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $175.90 $175.90 $182.68 $0.00 $49.39 $0.00 $0.00 $0.00 $0.00 $118.50 $187.70 $189.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000836 EAP Custom 27000836 Kit Thoracotomy BOTH IP/OP $217.00 $160.58 $0.00 $173.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $161.06 $161.06 $167.26 $0.00 $45.22 $0.00 $0.00 $0.00 $0.00 $108.50 $171.86 $173.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000841 EAP Custom 27000841 Pouch Fecal Incontinence BOTH IP/OP $52.00 $38.48 $0.00 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $38.59 $38.59 $40.08 $0.00 $10.84 $0.00 $0.00 $0.00 $0.00 $26.00 $41.18 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000842 EAP Custom 27000842 Kit Pressure Monitoring T BOTH IP/OP $177.00 $130.98 $0.00 $141.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $131.37 $131.37 $136.43 $0.00 $36.89 $0.00 $0.00 $0.00 $0.00 $88.50 $140.18 $141.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000843 EAP Custom 27000843 Kit Transducer Monitoring BOTH IP/OP $339.00 $250.86 $0.00 $271.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $251.61 $251.61 $261.30 $0.00 $70.65 $0.00 $0.00 $0.00 $0.00 $169.50 $268.49 $271.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000844 EAP Custom 27000844 Kit Pressure Monitoring BOTH IP/OP $250.00 $185.00 $0.00 $200.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $185.55 $185.55 $192.70 $0.00 $52.10 $0.00 $0.00 $0.00 $0.00 $125.00 $198.00 $200.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000846 EAP Custom 27000846 Bag 1000ml Pump Set BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000847 EAP Custom 27000847 Kit Pecutaneous Introduce BOTH IP/OP $298.00 $220.52 $0.00 $238.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $221.18 $221.18 $229.70 $0.00 $62.10 $0.00 $0.00 $0.00 $0.00 $149.00 $236.02 $238.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000848 EAP Custom 27000848 Chest Unit Drainage Pleur BOTH IP/OP $420.00 $310.80 $0.00 $336.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $311.72 $311.72 $323.74 $0.00 $87.53 $0.00 $0.00 $0.00 $0.00 $210.00 $332.64 $336.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000849 EAP Custom 27000849 Chest Unit Dry Suction Sy BOTH IP/OP $316.00 $233.84 $0.00 $252.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $234.54 $234.54 $243.57 $0.00 $65.85 $0.00 $0.00 $0.00 $0.00 $158.00 $250.27 $252.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000854 EAP Custom 27000854 Trac Dressing Xl BOTH IP/OP $70.00 $51.80 $0.00 $56.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $51.95 $51.95 $53.96 $0.00 $14.59 $0.00 $0.00 $0.00 $0.00 $35.00 $55.44 $56.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000857 EAP Custom 27000857 Tube Feeding Ng 8fr 36in Entr BOTH IP/OP $65.00 $48.10 $0.00 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $48.24 $48.24 $50.10 $0.00 $13.55 $0.00 $0.00 $0.00 $0.00 $32.50 $51.48 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000858 EAP Custom 27000858 Kit Triple Lumen Catheter BOTH IP/OP $697.00 $515.78 $0.00 $557.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $517.31 $517.31 $537.25 $0.00 $145.25 $0.00 $0.00 $0.00 $0.00 $348.50 $552.02 $557.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000859 EAP Custom 27000859 Catheter Swan Ganz BOTH IP/OP $726.00 $537.24 $0.00 $580.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $538.84 $538.84 $559.60 $0.00 $151.30 $0.00 $0.00 $0.00 $0.00 $363.00 $574.99 $580.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000860 EAP Custom 27000860 Delivery System Closed In BOTH IP/OP $152.00 $112.48 $0.00 $121.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $112.81 $112.81 $117.16 $0.00 $31.68 $0.00 $0.00 $0.00 $0.00 $76.00 $120.38 $121.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000866 EAP Custom 27000866 Tray Foley Perconnected 1 BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000868 EAP Custom 27000868 Tray Urine Meter 18fr BOTH IP/OP $94.00 $69.56 $0.00 $75.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $69.77 $69.77 $72.46 $0.00 $19.59 $0.00 $0.00 $0.00 $0.00 $47.00 $74.45 $75.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000869 EAP Custom 27000869 Kit Ventriculostomy BOTH IP/OP $763.00 $564.62 $0.00 $610.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $566.30 $566.30 $588.12 $0.00 $159.01 $0.00 $0.00 $0.00 $0.00 $381.50 $604.30 $610.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000870 EAP Custom 27000870 Tray Thoracentesis Dispos BOTH IP/OP $101.00 $74.74 $0.00 $80.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $74.96 $74.96 $77.85 $0.00 $21.05 $0.00 $0.00 $0.00 $0.00 $50.50 $79.99 $80.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000872 EAP Custom 27000872 Central Line Dressing Tray With Biopatch BOTH IP/OP $47.00 $34.78 $0.00 $37.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $34.88 $34.88 $36.23 $0.00 $9.79 $0.00 $0.00 $0.00 $0.00 $23.50 $37.22 $37.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000880 EAP Custom 27000880 Femoral Arterial Line Kit BOTH IP/OP $178.00 $131.72 $0.00 $142.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $132.11 $132.11 $137.20 $0.00 $37.10 $0.00 $0.00 $0.00 $0.00 $89.00 $140.98 $142.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000881 EAP Custom 27000881 Sleeve Knee Regular Dvt BOTH IP/OP $388.00 $287.12 $0.00 $310.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $287.97 $287.97 $299.07 $0.00 $80.86 $0.00 $0.00 $0.00 $0.00 $194.00 $307.30 $310.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000882 EAP Custom 27000882 Sleeve Knee X-large Dvt BOTH IP/OP $469.00 $347.06 $0.00 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $348.09 $348.09 $361.51 $0.00 $97.74 $0.00 $0.00 $0.00 $0.00 $234.50 $371.45 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000883 EAP Custom 27000883 Sleeve Thigh Regular Dvt BOTH IP/OP $553.00 $409.22 $0.00 $442.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $410.44 $410.44 $426.25 $0.00 $115.25 $0.00 $0.00 $0.00 $0.00 $276.50 $437.98 $442.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000884 EAP Custom 27000884 Sleeve Thigh X-large Dvt BOTH IP/OP $284.00 $210.16 $0.00 $227.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $210.78 $210.78 $218.91 $0.00 $59.19 $0.00 $0.00 $0.00 $0.00 $142.00 $224.93 $227.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000886 EAP Custom 27000886 Med/surg Isolation Supplies BOTH IP/OP $281.00 $207.94 $0.00 $224.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $208.56 $208.56 $216.59 $0.00 $58.56 $0.00 $0.00 $0.00 $0.00 $140.50 $222.55 $224.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000887 EAP Custom 27000887 Med/pri Supplies BOTH IP/OP $64.00 $47.36 $0.00 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $47.50 $47.50 $49.33 $0.00 $13.34 $0.00 $0.00 $0.00 $0.00 $32.00 $50.69 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000888 EAP Custom 27000888 Med/surg Semi-supplies BOTH IP/OP $64.00 $47.36 $0.00 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $47.50 $47.50 $49.33 $0.00 $13.34 $0.00 $0.00 $0.00 $0.00 $32.00 $50.69 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000902 EAP Custom 27000902 Catheter Thoracic 28fr BOTH IP/OP $43.00 $31.82 $0.00 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $21.50 $34.06 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000903 EAP Custom 27000903 Catheter Thoracic 32fr BOTH IP/OP $40.00 $29.60 $0.00 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $29.69 $29.69 $30.83 $0.00 $8.34 $0.00 $0.00 $0.00 $0.00 $20.00 $31.68 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000904 EAP Custom 27000904 Catheter Thoracic 36fr BOTH IP/OP $43.00 $31.82 $0.00 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $31.91 $31.91 $33.14 $0.00 $8.96 $0.00 $0.00 $0.00 $0.00 $21.50 $34.06 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000905 EAP HCPCS C1729 Catheter Foley 16fr BOTH IP/OP $18.00 $13.32 $0.00 $14.40 $9.77 $9.77 $0.00 $0.00 $0.00 $3.75 $13.36 $13.36 $13.87 $0.00 $3.75 $0.00 $10.65 $10.65 $0.00 $9.00 $14.26 $14.40 $0.00 $0.00 $0.00 $2.82 $0.00 $0.00 $2.87 $0.00 $0.00 $0.00 $0.00 $0.00 27000906 EAP HCPCS C1729 Catheter Coude Size 14fr BOTH IP/OP $109.00 $80.66 $0.00 $87.20 $59.19 $59.19 $0.00 $0.00 $0.00 $22.72 $80.90 $80.90 $84.02 $0.00 $22.72 $0.00 $64.47 $64.47 $0.00 $54.50 $86.33 $87.20 $0.00 $0.00 $0.00 $17.06 $0.00 $0.00 $17.35 $0.00 $0.00 $0.00 $0.00 $0.00 27000907 EAP HCPCS C1729 Catheter Coude Size 16fr BOTH IP/OP $109.00 $80.66 $0.00 $87.20 $59.19 $59.19 $0.00 $0.00 $0.00 $22.72 $80.90 $80.90 $84.02 $0.00 $22.72 $0.00 $64.47 $64.47 $0.00 $54.50 $86.33 $87.20 $0.00 $0.00 $0.00 $17.06 $0.00 $0.00 $17.35 $0.00 $0.00 $0.00 $0.00 $0.00 27000908 EAP Custom 27000908 Artery Arterial Catheriza BOTH IP/OP $109.00 $80.66 $0.00 $87.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $80.90 $80.90 $84.02 $0.00 $22.72 $0.00 $0.00 $0.00 $0.00 $54.50 $86.33 $87.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000909 EAP Custom 27000909 Artery Radial Catherizati BOTH IP/OP $69.00 $51.06 $0.00 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $51.21 $51.21 $53.19 $0.00 $14.38 $0.00 $0.00 $0.00 $0.00 $34.50 $54.65 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000910 EAP Custom 27000910 Tube Salem Sump 48 Lengt BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000911 EAP Custom 27000911 Tube Salem Silicone Size BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000912 EAP Custom 27000912 Tubes Salem Sump 48 Leng BOTH IP/OP $16.00 $11.84 $0.00 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.88 $11.88 $12.33 $0.00 $3.33 $0.00 $0.00 $0.00 $0.00 $8.00 $12.67 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000915 EAP Custom 27000915 Tray Catheter Insrtn Dulm BOTH IP/OP $937.00 $693.38 $0.00 $749.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $695.44 $695.44 $722.24 $0.00 $195.27 $0.00 $0.00 $0.00 $0.00 $468.50 $742.10 $749.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000916 EAP Custom 27000916 Scaple Surg W/handle Atta BOTH IP/OP $142.00 $105.08 $0.00 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $105.39 $105.39 $109.45 $0.00 $29.59 $0.00 $0.00 $0.00 $0.00 $71.00 $112.46 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000918 EAP Custom 27000918 Triconnector With Valve BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000922 EAP Custom 27000922 Pouch Active Life Squib Drain BOTH IP/OP $17.00 $12.58 $0.00 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $12.62 $12.62 $13.10 $0.00 $3.54 $0.00 $0.00 $0.00 $0.00 $8.50 $13.46 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000926 EAP Custom 27000926 Kit Thoracotomy BOTH IP/OP $210.00 $155.40 $0.00 $168.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $155.86 $155.86 $161.87 $0.00 $43.76 $0.00 $0.00 $0.00 $0.00 $105.00 $166.32 $168.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000931 EAP Custom 27000931 Pouch Fecal Incontinence BOTH IP/OP $52.00 $38.48 $0.00 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $38.59 $38.59 $40.08 $0.00 $10.84 $0.00 $0.00 $0.00 $0.00 $26.00 $41.18 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000932 EAP Custom 27000932 Kit Pressure Monitoring T BOTH IP/OP $177.00 $130.98 $0.00 $141.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $131.37 $131.37 $136.43 $0.00 $36.89 $0.00 $0.00 $0.00 $0.00 $88.50 $140.18 $141.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000933 EAP Custom 27000933 Kit Pressure Monitoring BOTH IP/OP $250.00 $185.00 $0.00 $200.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $185.55 $185.55 $192.70 $0.00 $52.10 $0.00 $0.00 $0.00 $0.00 $125.00 $198.00 $200.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000934 EAP Custom 27000934 Bag 1000ml Pump Set BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000935 EAP Custom 27000935 Needle Port-cath 20ga X 1 BOTH IP/OP $16.00 $11.84 $0.00 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.88 $11.88 $12.33 $0.00 $3.33 $0.00 $0.00 $0.00 $0.00 $8.00 $12.67 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000936 EAP Custom 27000936 Chest Unit Drainage Pleur BOTH IP/OP $455.00 $336.70 $0.00 $364.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $337.70 $337.70 $350.71 $0.00 $94.82 $0.00 $0.00 $0.00 $0.00 $227.50 $360.36 $364.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000941 EAP Custom 27000941 Dressing X-large BOTH IP/OP $321.00 $237.54 $0.00 $256.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $238.25 $238.25 $247.43 $0.00 $66.90 $0.00 $0.00 $0.00 $0.00 $160.50 $254.23 $256.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000942 EAP Custom 27000942 Trac Dressing Xl BOTH IP/OP $157.00 $116.18 $0.00 $125.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $116.53 $116.53 $121.02 $0.00 $32.72 $0.00 $0.00 $0.00 $0.00 $78.50 $124.34 $125.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000945 EAP Custom 27000945 Tube Feeding Ng 8fr 36in Entri BOTH IP/OP $65.00 $48.10 $0.00 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $48.24 $48.24 $50.10 $0.00 $13.55 $0.00 $0.00 $0.00 $0.00 $32.50 $51.48 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000946 EAP Custom 27000946 Kit Triple Lumen Catheter BOTH IP/OP $697.00 $515.78 $0.00 $557.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $517.31 $517.31 $537.25 $0.00 $145.25 $0.00 $0.00 $0.00 $0.00 $348.50 $552.02 $557.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000949 EAP Custom 27000949 Filter Set 0.22 Micron BOTH IP/OP $20.00 $14.80 $0.00 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.84 $14.84 $15.42 $0.00 $4.17 $0.00 $0.00 $0.00 $0.00 $10.00 $15.84 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000951 EAP Custom 27000951 Tray Foley Preconnected 1 BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000952 EAP Custom 27000952 Tray Foley Perconnected 1 BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000953 EAP Custom 27000953 Tray Thoracentesis Dispos BOTH IP/OP $235.00 $173.90 $0.00 $188.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $174.42 $174.42 $181.14 $0.00 $48.97 $0.00 $0.00 $0.00 $0.00 $117.50 $186.12 $188.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000955 EAP Custom 27000955 Central Line Dressing Tray With Biopatch BOTH IP/OP $47.00 $34.78 $0.00 $37.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $34.88 $34.88 $36.23 $0.00 $9.79 $0.00 $0.00 $0.00 $0.00 $23.50 $37.22 $37.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000962 EAP Custom 27000962 Sleeve Knee Regular Dvt BOTH IP/OP $370.00 $273.80 $0.00 $296.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $274.61 $274.61 $285.20 $0.00 $77.11 $0.00 $0.00 $0.00 $0.00 $185.00 $293.04 $296.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000963 EAP Custom 27000963 Sleeve Knee X-large Dvt BOTH IP/OP $450.00 $333.00 $0.00 $360.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $333.99 $333.99 $346.86 $0.00 $93.78 $0.00 $0.00 $0.00 $0.00 $225.00 $356.40 $360.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000964 EAP Custom 27000964 Sleeve Thigh Regular Dvt BOTH IP/OP $529.00 $391.46 $0.00 $423.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $392.62 $392.62 $407.75 $0.00 $110.24 $0.00 $0.00 $0.00 $0.00 $264.50 $418.97 $423.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000965 EAP Custom 27000965 Sleeve Thigh X-large Dvt BOTH IP/OP $488.00 $361.12 $0.00 $390.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $362.19 $362.19 $376.15 $0.00 $101.70 $0.00 $0.00 $0.00 $0.00 $244.00 $386.50 $390.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000968 EAP Custom 27000968 Dialysis Fluid Bag BOTH IP/OP $166.00 $122.84 $0.00 $132.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $123.21 $123.21 $127.95 $0.00 $34.59 $0.00 $0.00 $0.00 $0.00 $83.00 $131.47 $132.80 $0.00 $107.90 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000969 EAP Custom 27000969 Dialysis Filter BOTH IP/OP $699.00 $517.26 $0.00 $559.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $518.80 $518.80 $538.79 $0.00 $145.67 $0.00 $0.00 $0.00 $0.00 $349.50 $553.61 $559.20 $0.00 $454.35 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000975 EAP Custom 27000975 Ioban 2 Drape Incise Smal BOTH IP/OP $43.00 $31.82 $0.00 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $31.91 $31.91 $33.14 $0.00 $8.96 $0.00 $0.00 $0.00 $0.00 $21.50 $34.06 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000977 EAP Custom 27000977 Ioban 2 Drape Incise Larg BOTH IP/OP $462.00 $341.88 $0.00 $369.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $342.90 $342.90 $356.11 $0.00 $96.28 $0.00 $0.00 $0.00 $0.00 $231.00 $365.90 $369.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000978 EAP Custom 27000978 Needle Spinal 18ga BOTH IP/OP $16.00 $11.84 $0.00 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.88 $11.88 $12.33 $0.00 $3.33 $0.00 $0.00 $0.00 $0.00 $8.00 $12.67 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000982 EAP Custom 27000982 Catheter Thoracic 32fr BOTH IP/OP $43.00 $31.82 $0.00 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $31.91 $31.91 $33.14 $0.00 $8.96 $0.00 $0.00 $0.00 $0.00 $21.50 $34.06 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000983 EAP Custom 27000983 Catheter Thoracic 36fr BOTH IP/OP $43.00 $31.82 $0.00 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $31.91 $31.91 $33.14 $0.00 $8.96 $0.00 $0.00 $0.00 $0.00 $21.50 $34.06 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000984 EAP Custom 27000984 Catheter Urethral Two-eye BOTH IP/OP $7.00 $5.18 $0.00 $5.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $5.20 $5.20 $5.40 $0.00 $1.46 $0.00 $0.00 $0.00 $0.00 $3.50 $5.54 $5.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000985 EAP HCPCS C1729 Catheter Foley 5cc 14fr BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $10.32 $10.32 $0.00 $0.00 $0.00 $3.96 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $11.24 $11.24 $0.00 $9.50 $15.05 $15.20 $0.00 $0.00 $0.00 $2.97 $0.00 $0.00 $3.02 $0.00 $0.00 $0.00 $0.00 $0.00 27000986 EAP HCPCS C1729 Catheter Foley 16fr BOTH IP/OP $18.00 $13.32 $0.00 $14.40 $9.77 $9.77 $0.00 $0.00 $0.00 $3.75 $13.36 $13.36 $13.87 $0.00 $3.75 $0.00 $10.65 $10.65 $0.00 $9.00 $14.26 $14.40 $0.00 $11.70 $0.00 $2.82 $0.00 $0.00 $2.87 $0.00 $0.00 $0.00 $0.00 $0.00 27000987 EAP HCPCS C1729 Catheter Foley 5cc 18fr BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $10.32 $10.32 $0.00 $0.00 $0.00 $3.96 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $11.24 $11.24 $0.00 $9.50 $15.05 $15.20 $0.00 $0.00 $0.00 $2.97 $0.00 $0.00 $3.02 $0.00 $0.00 $0.00 $0.00 $0.00 27000988 EAP HCPCS C1729 Catheter Foley 3-way 30cc BOTH IP/OP $37.00 $27.38 $0.00 $29.60 $20.09 $20.09 $0.00 $0.00 $0.00 $7.71 $27.46 $27.46 $28.52 $0.00 $7.71 $0.00 $21.89 $21.89 $0.00 $18.50 $29.30 $29.60 $0.00 $0.00 $0.00 $5.79 $0.00 $0.00 $5.89 $0.00 $0.00 $0.00 $0.00 $0.00 27000989 EAP Custom 27000989 Catheter Ventricular 20cm BOTH IP/OP $313.00 $231.62 $0.00 $250.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $232.31 $232.31 $241.26 $0.00 $65.23 $0.00 $0.00 $0.00 $0.00 $156.50 $247.90 $250.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000990 EAP Custom 27000990 Catheter Edm Ii Becker BOTH IP/OP $617.00 $456.58 $0.00 $493.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $457.94 $457.94 $475.58 $0.00 $128.58 $0.00 $0.00 $0.00 $0.00 $308.50 $488.66 $493.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000991 EAP Custom 27000991 Artery Arterial Catheriza BOTH IP/OP $109.00 $80.66 $0.00 $87.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $80.90 $80.90 $84.02 $0.00 $22.72 $0.00 $0.00 $0.00 $0.00 $54.50 $86.33 $87.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000992 EAP Custom 27000992 Artery Radial Catherizati BOTH IP/OP $69.00 $51.06 $0.00 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $51.21 $51.21 $53.19 $0.00 $14.38 $0.00 $0.00 $0.00 $0.00 $34.50 $54.65 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000993 EAP Custom 27000993 Tube Salem Sump 48 Lengt BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000994 EAP Custom 27000994 Tube Salem Silicone Size BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000995 EAP Custom 27000995 Tubes Salem Sump 48 Leng BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000996 EAP Custom 27000996 Kit Percuatane Trache 7fr BOTH IP/OP "$1,219.00 " $902.06 $0.00 $975.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $904.74 $904.74 $939.61 $0.00 $254.04 $0.00 $0.00 $0.00 $0.00 $609.50 $965.45 $975.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000997 EAP Custom 27000997 Kit Percuatane Trache 8fr BOTH IP/OP "$1,424.00 " "$1,053.76" $0.00 "$1,139.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,056.89" "$1,056.89" "$1,097.62" $0.00 $296.76 $0.00 $0.00 $0.00 $0.00 $712.00 "$1,127.81" "$1,139.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27000998 EAP Custom 27000998 Kit Tracheotomy Care Ster BOTH IP/OP $65.00 $48.10 $0.00 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $48.24 $48.24 $50.10 $0.00 $13.55 $0.00 $0.00 $0.00 $0.00 $32.50 $51.48 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001001 EAP Custom 27001001 Bag Drainage Becker BOTH IP/OP $213.00 $157.62 $0.00 $170.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $158.09 $158.09 $164.18 $0.00 $44.39 $0.00 $0.00 $0.00 $0.00 $106.50 $168.70 $170.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001002 EAP Custom 27001002 Tray Catheter Insrtn Dulm BOTH IP/OP $937.00 $693.38 $0.00 $749.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $695.44 $695.44 $722.24 $0.00 $195.27 $0.00 $0.00 $0.00 $0.00 $468.50 $742.10 $749.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001006 EAP Custom 27001006 Scapel Surg W/handle Atta BOTH IP/OP $142.00 $105.08 $0.00 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $105.39 $105.39 $109.45 $0.00 $29.59 $0.00 $0.00 $0.00 $0.00 $71.00 $112.46 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001007 EAP Custom 27001007 Scaple Surg W/handle Atta BOTH IP/OP $152.00 $112.48 $0.00 $121.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $112.81 $112.81 $117.16 $0.00 $31.68 $0.00 $0.00 $0.00 $0.00 $76.00 $120.38 $121.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001009 EAP Custom 27001009 Triconnector With Valve BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001012 EAP Custom 27001012 Cream Baza 5oz BOTH IP/OP $63.00 $46.62 $0.00 $50.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $46.76 $46.76 $48.56 $0.00 $13.13 $0.00 $0.00 $0.00 $0.00 $31.50 $49.90 $50.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001016 EAP Custom 27001016 Valve Anti-reflux Salem S BOTH IP/OP $49.00 $36.26 $0.00 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $36.37 $36.37 $37.77 $0.00 $10.21 $0.00 $0.00 $0.00 $0.00 $24.50 $38.81 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001017 EAP Custom 27001017 Kit L.f. Trach Care BOTH IP/OP $237.00 $175.38 $0.00 $189.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $175.90 $175.90 $182.68 $0.00 $49.39 $0.00 $0.00 $0.00 $0.00 $118.50 $187.70 $189.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001019 EAP Custom 27001019 Kit Thoracotomy BOTH IP/OP $217.00 $160.58 $0.00 $173.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $108.50 $171.86 $173.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001025 EAP Custom 27001025 Pouch Fecal Incontinence BOTH IP/OP $52.00 $38.48 $0.00 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $38.59 $38.59 $40.08 $0.00 $10.84 $0.00 $0.00 $0.00 $0.00 $26.00 $41.18 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001026 EAP Custom 27001026 Kit Pressure Monitoring T BOTH IP/OP $177.00 $130.98 $0.00 $141.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $131.37 $131.37 $136.43 $0.00 $36.89 $0.00 $0.00 $0.00 $0.00 $88.50 $140.18 $141.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001027 EAP Custom 27001027 Transducer Disp For Icp BOTH IP/OP $79.00 $58.46 $0.00 $63.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $58.63 $58.63 $60.89 $0.00 $16.46 $0.00 $0.00 $0.00 $0.00 $39.50 $62.57 $63.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001028 EAP Custom 27001028 Kit Transducer Monitoring BOTH IP/OP $339.00 $250.86 $0.00 $271.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $251.61 $251.61 $261.30 $0.00 $70.65 $0.00 $0.00 $0.00 $0.00 $169.50 $268.49 $271.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001029 EAP Custom 27001029 Kit Pressure Monitoring BOTH IP/OP $250.00 $185.00 $0.00 $200.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $185.55 $185.55 $192.70 $0.00 $52.10 $0.00 $0.00 $0.00 $0.00 $125.00 $198.00 $200.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001031 EAP Custom 27001031 Bag 1000ml Pump Set BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001032 EAP Custom 27001032 Kit Pecutaneous Introduce BOTH IP/OP $298.00 $220.52 $0.00 $238.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $221.18 $221.18 $229.70 $0.00 $62.10 $0.00 $0.00 $0.00 $0.00 $149.00 $236.02 $238.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001033 EAP Custom 27001033 Chest Unit Drainage Pleur BOTH IP/OP $455.00 $336.70 $0.00 $364.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $337.70 $337.70 $350.71 $0.00 $94.82 $0.00 $0.00 $0.00 $0.00 $227.50 $360.36 $364.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001034 EAP Custom 27001034 Chest Unit Dry Suction Sy BOTH IP/OP $333.00 $246.42 $0.00 $266.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $247.15 $247.15 $256.68 $0.00 $69.40 $0.00 $0.00 $0.00 $0.00 $166.50 $263.74 $266.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001035 EAP Custom 27001035 Bag Auto-transfusion Ple BOTH IP/OP $245.00 $181.30 $0.00 $196.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $181.84 $181.84 $188.85 $0.00 $51.06 $0.00 $0.00 $0.00 $0.00 $122.50 $194.04 $196.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001040 EAP Custom 27001040 Dressing X-large BOTH IP/OP $682.00 $504.68 $0.00 $545.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $506.18 $506.18 $525.69 $0.00 $142.13 $0.00 $0.00 $0.00 $0.00 $341.00 $540.14 $545.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001041 EAP Custom 27001041 Trac Dressing Xl BOTH IP/OP $170.00 $125.80 $0.00 $136.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $126.17 $126.17 $131.04 $0.00 $35.43 $0.00 $0.00 $0.00 $0.00 $85.00 $134.64 $136.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001044 EAP Custom 27001044 Tube Feeding Ng 8fr 36in Entr BOTH IP/OP $65.00 $48.10 $0.00 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $48.24 $48.24 $50.10 $0.00 $13.55 $0.00 $0.00 $0.00 $0.00 $32.50 $51.48 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001045 EAP Custom 27001045 Kit Triple Lumen Catheter BOTH IP/OP $697.00 $515.78 $0.00 $557.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $517.31 $517.31 $537.25 $0.00 $145.25 $0.00 $0.00 $0.00 $0.00 $348.50 $552.02 $557.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001046 EAP Custom 27001046 Wire Guide Dual Purpose BOTH IP/OP $362.00 $267.88 $0.00 $289.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $268.68 $268.68 $279.03 $0.00 $75.44 $0.00 $0.00 $0.00 $0.00 $181.00 $286.70 $289.60 $0.00 $235.30 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001047 EAP Custom 27001047 Kit Monitoring Intracrani BOTH IP/OP $426.00 $315.24 $0.00 $340.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $316.18 $316.18 $328.36 $0.00 $88.78 $0.00 $0.00 $0.00 $0.00 $213.00 $337.39 $340.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001048 EAP Custom 27001048 Cath Trauma Ventricular BOTH IP/OP $438.00 $324.12 $0.00 $350.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $219.00 $346.90 $350.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001049 EAP Custom 27001049 Catheter Swan Ganz BOTH IP/OP $309.00 $228.66 $0.00 $247.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $229.34 $229.34 $238.18 $0.00 $64.40 $0.00 $0.00 $0.00 $0.00 $154.50 $244.73 $247.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001050 EAP Custom 27001050 Delivery System Closed In BOTH IP/OP $152.00 $112.48 $0.00 $121.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $112.81 $112.81 $117.16 $0.00 $31.68 $0.00 $0.00 $0.00 $0.00 $76.00 $120.38 $121.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001051 EAP Custom 27001051 Probe V-pacing BOTH IP/OP "$1,277.00 " $944.98 $0.00 "$1,021.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $947.79 $947.79 $984.31 $0.00 $266.13 $0.00 $0.00 $0.00 $0.00 $638.50 "$1,011.38" "$1,021.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001055 EAP Custom 27001055 Filter Set 0.22 Micron BOTH IP/OP $20.00 $14.80 $0.00 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.84 $14.84 $15.42 $0.00 $4.17 $0.00 $0.00 $0.00 $0.00 $10.00 $15.84 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001057 EAP Custom 27001057 Tray Foley Preconnected 1 BOTH IP/OP $52.00 $38.48 $0.00 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $38.59 $38.59 $40.08 $0.00 $10.84 $0.00 $0.00 $0.00 $0.00 $26.00 $41.18 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001058 EAP Custom 27001058 Tray Foley Perconnected 1 BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001060 EAP Custom 27001060 Tray Urine Meter 18fr BOTH IP/OP $94.00 $69.56 $0.00 $75.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $69.77 $69.77 $72.46 $0.00 $19.59 $0.00 $0.00 $0.00 $0.00 $47.00 $74.45 $75.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001061 EAP Custom 27001061 Kit Ventriculostomy BOTH IP/OP "$1,782.00 " "$1,318.68" $0.00 "$1,425.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,322.60" "$1,322.60" "$1,373.57" $0.00 $371.37 $0.00 $0.00 $0.00 $0.00 $891.00 "$1,411.34" "$1,425.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001062 EAP Custom 27001062 Tray Thoracentesis Dispos BOTH IP/OP $101.00 $74.74 $0.00 $80.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $74.96 $74.96 $77.85 $0.00 $21.05 $0.00 $0.00 $0.00 $0.00 $50.50 $79.99 $80.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001063 EAP Custom 27001063 Central Line Dressing Tray With Biopatch BOTH IP/OP $47.00 $34.78 $0.00 $37.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $34.88 $34.88 $36.23 $0.00 $9.79 $0.00 $0.00 $0.00 $0.00 $23.50 $37.22 $37.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001064 EAP Custom 27001064 Bag Drainage Ureteral BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001078 EAP Custom 27001078 Femoral Arterial Line Kit BOTH IP/OP $172.00 $127.28 $0.00 $137.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $127.66 $127.66 $132.58 $0.00 $35.84 $0.00 $0.00 $0.00 $0.00 $86.00 $136.22 $137.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001079 EAP Custom 27001079 Kit Percutane Trache 9fr BOTH IP/OP "$3,007.00 " "$2,225.18" $0.00 "$2,405.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,231.80" "$2,231.80" "$2,317.80" $0.00 $626.66 $0.00 $0.00 $0.00 $0.00 "$1,503.50" "$2,381.54" "$2,405.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001081 EAP Custom 27001081 Cath Cco Swan Ganz 8fr BOTH IP/OP "$2,182.00 " "$1,614.68" $0.00 "$1,745.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,091.00" "$1,728.14" "$1,745.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001082 EAP Custom 27001082 Sleeve Knee Regular Dvt BOTH IP/OP $388.00 $287.12 $0.00 $310.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $287.97 $287.97 $299.07 $0.00 $80.86 $0.00 $0.00 $0.00 $0.00 $194.00 $307.30 $310.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001083 EAP Custom 27001083 Sleeve Knee X-large Dvt BOTH IP/OP $469.00 $347.06 $0.00 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $348.09 $348.09 $361.51 $0.00 $97.74 $0.00 $0.00 $0.00 $0.00 $234.50 $371.45 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001084 EAP Custom 27001084 Sleeve Thigh Regular Dvt BOTH IP/OP $553.00 $409.22 $0.00 $442.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $410.44 $410.44 $426.25 $0.00 $115.25 $0.00 $0.00 $0.00 $0.00 $276.50 $437.98 $442.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001085 EAP Custom 27001085 Sleeve Thigh X-large Dvt BOTH IP/OP $284.00 $210.16 $0.00 $227.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $210.78 $210.78 $218.91 $0.00 $59.19 $0.00 $0.00 $0.00 $0.00 $142.00 $224.93 $227.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001086 EAP Custom 27001086 First Step Select Overlay BOTH IP/OP $60.00 $44.40 $0.00 $48.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $44.53 $44.53 $46.25 $0.00 $12.50 $0.00 $0.00 $0.00 $0.00 $30.00 $47.52 $48.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001096 EAP Custom 27001096 Dialysis Filter BOTH IP/OP $300.00 $222.00 $0.00 $240.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $222.66 $222.66 $231.24 $0.00 $62.52 $0.00 $0.00 $0.00 $0.00 $150.00 $237.60 $240.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001101 EAP Custom 27001101 Needle Spinal 22ga X 3-1/ BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001106 EAP Custom 27001106 Catheter Thoracic 28fr BOTH IP/OP $18.00 $13.32 $0.00 $14.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.00 $14.26 $14.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001107 EAP Custom 27001107 Catheter Thoracic 32fr BOTH IP/OP $43.00 $31.82 $0.00 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $31.91 $31.91 $33.14 $0.00 $8.96 $0.00 $0.00 $0.00 $0.00 $21.50 $34.06 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001108 EAP Custom 27001108 Catheter Thoracic 36fr BOTH IP/OP $43.00 $31.82 $0.00 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $31.91 $31.91 $33.14 $0.00 $8.96 $0.00 $0.00 $0.00 $0.00 $21.50 $34.06 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001109 EAP HCPCS C1729 Catheter Foley 5cc 14fr BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $10.32 $10.32 $0.00 $0.00 $0.00 $3.96 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $11.24 $11.24 $0.00 $9.50 $15.05 $15.20 $0.00 $0.00 $0.00 $2.97 $0.00 $0.00 $3.02 $0.00 $0.00 $0.00 $0.00 $0.00 27001110 EAP HCPCS C1729 Catheter Foley 16fr BOTH IP/OP $18.00 $13.32 $0.00 $14.40 $9.77 $9.77 $0.00 $0.00 $0.00 $3.75 $13.36 $13.36 $13.87 $0.00 $3.75 $0.00 $10.65 $10.65 $0.00 $9.00 $14.26 $14.40 $0.00 $0.00 $0.00 $2.82 $0.00 $0.00 $2.87 $0.00 $0.00 $0.00 $0.00 $0.00 27001111 EAP HCPCS C1729 Catheter Foley 5cc 18fr BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $10.32 $10.32 $0.00 $0.00 $0.00 $3.96 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $11.24 $11.24 $0.00 $9.50 $15.05 $15.20 $0.00 $12.35 $0.00 $2.97 $0.00 $0.00 $3.02 $0.00 $0.00 $0.00 $0.00 $0.00 27001112 EAP HCPCS C1729 Catheter Foley 30cc 28fr BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $21.18 $21.18 $0.00 $0.00 $0.00 $8.13 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $23.07 $23.07 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $6.10 $0.00 $0.00 $6.21 $0.00 $0.00 $0.00 $0.00 $0.00 27001113 EAP Custom 27001113 Catheter Ventricular 20cm BOTH IP/OP $735.00 $543.90 $0.00 $588.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $545.52 $545.52 $566.54 $0.00 $153.17 $0.00 $0.00 $0.00 $0.00 $367.50 $582.12 $588.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001114 EAP Custom 27001114 Catheter Edm Ii Becker BOTH IP/OP "$1,440.00 " "$1,065.60" $0.00 "$1,152.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,068.77" "$1,068.77" "$1,109.95" $0.00 $300.10 $0.00 $0.00 $0.00 $0.00 $720.00 "$1,140.48" "$1,152.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001115 EAP Custom 27001115 Tube Feeding Ng 8fr 43in En BOTH IP/OP $65.00 $48.10 $0.00 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $48.24 $48.24 $50.10 $0.00 $13.55 $0.00 $0.00 $0.00 $0.00 $32.50 $51.48 $52.00 $0.00 $42.25 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001116 EAP Custom 27001116 Artery Arterial Catheriza BOTH IP/OP $109.00 $80.66 $0.00 $87.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $80.90 $80.90 $84.02 $0.00 $22.72 $0.00 $0.00 $0.00 $0.00 $54.50 $86.33 $87.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001117 EAP Custom 27001117 Artery Radial Catherizati BOTH IP/OP $69.00 $51.06 $0.00 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $51.21 $51.21 $53.19 $0.00 $14.38 $0.00 $0.00 $0.00 $0.00 $34.50 $54.65 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001118 EAP Custom 27001118 Tube Salem Sump 48 Lengt BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001119 EAP Custom 27001119 Tube Salem Silicone Size BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001120 EAP Custom 27001120 Tubes Salem Sump 48 Leng BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001124 EAP Custom 27001124 Bag Drainage Becker BOTH IP/OP $213.00 $157.62 $0.00 $170.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $158.09 $158.09 $164.18 $0.00 $44.39 $0.00 $0.00 $0.00 $0.00 $106.50 $168.70 $170.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001125 EAP Custom 27001125 Blades Surgical #10 W/o H BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001126 EAP Custom 27001126 Scapel Surg W/handle Atta BOTH IP/OP $142.00 $105.08 $0.00 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $105.39 $105.39 $109.45 $0.00 $29.59 $0.00 $0.00 $0.00 $0.00 $71.00 $112.46 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001127 EAP Custom 27001127 Triconnector With Valve BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001129 EAP Custom 27001129 Set Blood Administration BOTH IP/OP $36.00 $26.64 $0.00 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $26.72 $26.72 $27.75 $0.00 $7.50 $0.00 $0.00 $0.00 $0.00 $18.00 $28.51 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001135 EAP Custom 27001135 Valve Anti-reflux Salem S BOTH IP/OP $49.00 $36.26 $0.00 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $36.37 $36.37 $37.77 $0.00 $10.21 $0.00 $0.00 $0.00 $0.00 $24.50 $38.81 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001137 EAP Custom 27001137 Kit Thoracotomy BOTH IP/OP $217.00 $160.58 $0.00 $173.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $161.06 $161.06 $167.26 $0.00 $45.22 $0.00 $0.00 $0.00 $0.00 $108.50 $171.86 $173.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001142 EAP Custom 27001142 Pouch Fecal Incontinence BOTH IP/OP $52.00 $38.48 $0.00 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $38.59 $38.59 $40.08 $0.00 $10.84 $0.00 $0.00 $0.00 $0.00 $26.00 $41.18 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001143 EAP Custom 27001143 Kit Pressure Monitoring T BOTH IP/OP $177.00 $130.98 $0.00 $141.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $131.37 $131.37 $136.43 $0.00 $36.89 $0.00 $0.00 $0.00 $0.00 $88.50 $140.18 $141.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001144 EAP Custom 27001144 Transducer Disp For Icp BOTH IP/OP $79.00 $58.46 $0.00 $63.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $58.63 $58.63 $60.89 $0.00 $16.46 $0.00 $0.00 $0.00 $0.00 $39.50 $62.57 $63.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001145 EAP Custom 27001145 Bridge Kit Bifurated Resp BOTH IP/OP $120.00 $88.80 $0.00 $96.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $89.06 $89.06 $92.50 $0.00 $25.01 $0.00 $0.00 $0.00 $0.00 $60.00 $95.04 $96.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001146 EAP Custom 27001146 Kit Transducer Monitoring BOTH IP/OP $339.00 $250.86 $0.00 $271.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $251.61 $251.61 $261.30 $0.00 $70.65 $0.00 $0.00 $0.00 $0.00 $169.50 $268.49 $271.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001147 EAP Custom 27001147 Kit Pressure Monitoring BOTH IP/OP $250.00 $185.00 $0.00 $200.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $185.55 $185.55 $192.70 $0.00 $52.10 $0.00 $0.00 $0.00 $0.00 $125.00 $198.00 $200.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001149 EAP Custom 27001149 Bag 1000ml Pump Set BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001150 EAP Custom 27001150 Kit Pecutaneous Introduce BOTH IP/OP $276.00 $204.24 $0.00 $220.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $204.85 $204.85 $212.74 $0.00 $57.52 $0.00 $0.00 $0.00 $0.00 $138.00 $218.59 $220.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001151 EAP Custom 27001151 Chest Unit Drainage Pleur BOTH IP/OP $401.00 $296.74 $0.00 $320.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $297.62 $297.62 $309.09 $0.00 $83.57 $0.00 $0.00 $0.00 $0.00 $200.50 $317.59 $320.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001152 EAP Custom 27001152 Chest Unit Dry Suction Sy BOTH IP/OP $316.00 $233.84 $0.00 $252.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $234.54 $234.54 $243.57 $0.00 $65.85 $0.00 $0.00 $0.00 $0.00 $158.00 $250.27 $252.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001157 EAP Custom 27001157 Dressing X-large BOTH IP/OP $697.00 $515.78 $0.00 $557.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $517.31 $517.31 $537.25 $0.00 $145.25 $0.00 $0.00 $0.00 $0.00 $348.50 $552.02 $557.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001158 EAP Custom 27001158 Trac Dressing Xl BOTH IP/OP $157.00 $116.18 $0.00 $125.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $116.53 $116.53 $121.02 $0.00 $32.72 $0.00 $0.00 $0.00 $0.00 $78.50 $124.34 $125.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001161 EAP Custom 27001161 Tube Feeding Ng 8fr 36in Entr BOTH IP/OP $65.00 $48.10 $0.00 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $48.24 $48.24 $50.10 $0.00 $13.55 $0.00 $0.00 $0.00 $0.00 $32.50 $51.48 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001162 EAP Custom 27001162 Kit Triple Lumen Catheter BOTH IP/OP $344.00 $254.56 $0.00 $275.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $255.32 $255.32 $265.16 $0.00 $71.69 $0.00 $0.00 $0.00 $0.00 $172.00 $272.45 $275.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001163 EAP Custom 27001163 Wire Guide Dual Purpose BOTH IP/OP $392.00 $290.08 $0.00 $313.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $290.94 $290.94 $302.15 $0.00 $81.69 $0.00 $0.00 $0.00 $0.00 $196.00 $310.46 $313.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001164 EAP Custom 27001164 Kit Monitoring Intracrani BOTH IP/OP $460.00 $340.40 $0.00 $368.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $341.41 $341.41 $354.57 $0.00 $95.86 $0.00 $0.00 $0.00 $0.00 $230.00 $364.32 $368.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001165 EAP Custom 27001165 Cath Trauma Ventricular BOTH IP/OP "$1,014.00 " $750.36 $0.00 $811.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $507.00 $803.09 $811.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001166 EAP Custom 27001166 Catheter Swan Ganz BOTH IP/OP $309.00 $228.66 $0.00 $247.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $229.34 $229.34 $238.18 $0.00 $64.40 $0.00 $0.00 $0.00 $0.00 $154.50 $244.73 $247.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001167 EAP Custom 27001167 Delivery System Closed In BOTH IP/OP $65.00 $48.10 $0.00 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $48.24 $48.24 $50.10 $0.00 $13.55 $0.00 $0.00 $0.00 $0.00 $32.50 $51.48 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001173 EAP Custom 27001173 Filter Set 0.22 Micron BOTH IP/OP $20.00 $14.80 $0.00 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.84 $14.84 $15.42 $0.00 $4.17 $0.00 $0.00 $0.00 $0.00 $10.00 $15.84 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001174 EAP Custom 27001174 Tray Catheter Urethral 14 BOTH IP/OP $17.00 $12.58 $0.00 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $12.62 $12.62 $13.10 $0.00 $3.54 $0.00 $0.00 $0.00 $0.00 $8.50 $13.46 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001176 EAP Custom 27001176 Kit Ventriculostomy BOTH IP/OP "$1,782.00 " "$1,318.68" $0.00 "$1,425.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,322.60" "$1,322.60" "$1,373.57" $0.00 $371.37 $0.00 $0.00 $0.00 $0.00 $891.00 "$1,411.34" "$1,425.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001178 EAP Custom 27001178 Central Line Dressing Tray With Biopatch BOTH IP/OP $47.00 $34.78 $0.00 $37.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $34.88 $34.88 $36.23 $0.00 $9.79 $0.00 $0.00 $0.00 $0.00 $23.50 $37.22 $37.60 $0.00 $30.55 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001179 EAP Custom 27001179 Kit Lumbar Drainage Edm BOTH IP/OP $788.00 $583.12 $0.00 $630.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $584.85 $584.85 $607.39 $0.00 $164.22 $0.00 $0.00 $0.00 $0.00 $394.00 $624.10 $630.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001190 EAP Custom 27001190 Sleeve Knee Regular Dvt BOTH IP/OP $388.00 $287.12 $0.00 $310.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $287.97 $287.97 $299.07 $0.00 $80.86 $0.00 $0.00 $0.00 $0.00 $194.00 $307.30 $310.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001191 EAP Custom 27001191 Sleeve Knee X-large Dvt BOTH IP/OP $469.00 $347.06 $0.00 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $348.09 $348.09 $361.51 $0.00 $97.74 $0.00 $0.00 $0.00 $0.00 $234.50 $371.45 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001192 EAP Custom 27001192 Sleeve Thigh Regular Dvt BOTH IP/OP $553.00 $409.22 $0.00 $442.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $410.44 $410.44 $426.25 $0.00 $115.25 $0.00 $0.00 $0.00 $0.00 $276.50 $437.98 $442.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001193 EAP Custom 27001193 Sleeve Thigh X-large Dvt BOTH IP/OP $663.00 $490.62 $0.00 $530.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $492.08 $492.08 $511.04 $0.00 $138.17 $0.00 $0.00 $0.00 $0.00 $331.50 $525.10 $530.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001194 EAP Custom 27001194 First Step Select Overlay BOTH IP/OP $131.00 $96.94 $0.00 $104.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $97.23 $97.23 $100.97 $0.00 $27.30 $0.00 $0.00 $0.00 $0.00 $65.50 $103.75 $104.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001205 EAP Custom 27001205 Dialysis Filter BOTH IP/OP $651.00 $481.74 $0.00 $520.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $483.17 $483.17 $501.79 $0.00 $135.67 $0.00 $0.00 $0.00 $0.00 $325.50 $515.59 $520.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001206 EAP Custom 27001206 Tubes Extension Plain Pla BOTH IP/OP $15.00 $11.10 $0.00 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.13 $11.13 $11.56 $0.00 $3.13 $0.00 $0.00 $0.00 $0.00 $7.50 $11.88 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001218 EAP Custom 27001218 Catheter Thoracic 16f BOTH IP/OP $40.00 $29.60 $0.00 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $29.69 $29.69 $30.83 $0.00 $8.34 $0.00 $0.00 $0.00 $0.00 $20.00 $31.68 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001219 EAP Custom 27001219 Catheter Thoracic 20fr BOTH IP/OP $40.00 $29.60 $0.00 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $29.69 $29.69 $30.83 $0.00 $8.34 $0.00 $0.00 $0.00 $0.00 $20.00 $31.68 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001220 EAP Custom 27001220 Catheter Thoracic 24fr BOTH IP/OP $18.00 $13.32 $0.00 $14.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $13.36 $13.36 $13.87 $0.00 $3.75 $0.00 $0.00 $0.00 $0.00 $9.00 $14.26 $14.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001221 EAP Custom 27001221 Catheter Thoracic 28fr BOTH IP/OP $18.00 $13.32 $0.00 $14.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $13.36 $13.36 $13.87 $0.00 $3.75 $0.00 $0.00 $0.00 $0.00 $9.00 $14.26 $14.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001222 EAP Custom 27001222 Catheter Thoracic 32fr BOTH IP/OP $18.00 $13.32 $0.00 $14.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $13.36 $13.36 $13.87 $0.00 $3.75 $0.00 $0.00 $0.00 $0.00 $9.00 $14.26 $14.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001223 EAP Custom 27001223 Catheter Urethral 8fr BOTH IP/OP $31.00 $22.94 $0.00 $24.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $23.01 $23.01 $23.89 $0.00 $6.46 $0.00 $0.00 $0.00 $0.00 $15.50 $24.55 $24.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001224 EAP Custom 27001224 Entriflex BOTH IP/OP $30.00 $22.20 $0.00 $24.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $22.27 $22.27 $23.12 $0.00 $6.25 $0.00 $0.00 $0.00 $0.00 $15.00 $23.76 $24.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001225 EAP Custom 27001225 Tube Feeding Nasogastric BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $6.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001226 EAP Custom 27001226 Artery Arterial Catheriza BOTH IP/OP $109.00 $80.66 $0.00 $87.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $80.90 $80.90 $84.02 $0.00 $22.72 $0.00 $0.00 $0.00 $0.00 $54.50 $86.33 $87.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001227 EAP Custom 27001227 Artery Radial Catherizati BOTH IP/OP $69.00 $51.06 $0.00 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $51.21 $51.21 $53.19 $0.00 $14.38 $0.00 $0.00 $0.00 $0.00 $34.50 $54.65 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001228 EAP Custom 27001228 Tube Salem Sump 48 Lengt BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001229 EAP Custom 27001229 Tubes Salem Sump 48 Leng BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001231 EAP Custom 27001231 Set Urinary Drain W/conta BOTH IP/OP $21.00 $15.54 $0.00 $16.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $15.59 $15.59 $16.19 $0.00 $4.38 $0.00 $0.00 $0.00 $0.00 $10.50 $16.63 $16.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001232 EAP Custom 27001232 Tray Catheter Insrtn Dulm BOTH IP/OP $434.00 $321.16 $0.00 $347.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $322.11 $322.11 $334.53 $0.00 $90.45 $0.00 $0.00 $0.00 $0.00 $217.00 $343.73 $347.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001234 EAP Custom 27001234 Scapel Surg W/handle Atta BOTH IP/OP $142.00 $105.08 $0.00 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $105.39 $105.39 $109.45 $0.00 $29.59 $0.00 $0.00 $0.00 $0.00 $71.00 $112.46 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001235 EAP Custom 27001235 Stapler Skin Disposable 3 BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $24.70 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001236 EAP Custom 27001236 Triconnector With Valve BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001240 EAP Custom 27001240 Aquacel Ag 4x4 BOTH IP/OP $92.00 $68.08 $0.00 $73.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $68.28 $68.28 $70.91 $0.00 $19.17 $0.00 $0.00 $0.00 $0.00 $46.00 $72.86 $73.60 $0.00 $59.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001243 EAP Custom 27001243 Electrodes Operative BOTH IP/OP $289.00 $213.86 $0.00 $231.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $214.50 $214.50 $222.76 $0.00 $60.23 $0.00 $0.00 $0.00 $0.00 $144.50 $228.89 $231.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001249 EAP Custom 27001249 Kit Pressure Monitoring T BOTH IP/OP $177.00 $130.98 $0.00 $141.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $131.37 $131.37 $136.43 $0.00 $36.89 $0.00 $0.00 $0.00 $0.00 $88.50 $140.18 $141.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001250 EAP Custom 27001250 Kit Transducer Monitoring BOTH IP/OP $339.00 $250.86 $0.00 $271.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $251.61 $251.61 $261.30 $0.00 $70.65 $0.00 $0.00 $0.00 $0.00 $169.50 $268.49 $271.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001252 EAP Custom 27001252 Kit Pressure Monitoring BOTH IP/OP $250.00 $185.00 $0.00 $200.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $185.55 $185.55 $192.70 $0.00 $52.10 $0.00 $0.00 $0.00 $0.00 $125.00 $198.00 $200.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001254 EAP Custom 27001254 Bag 1000ml Pump Set BOTH IP/OP $28.00 $20.72 $0.00 $22.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $20.78 $20.78 $21.58 $0.00 $5.84 $0.00 $0.00 $0.00 $0.00 $14.00 $22.18 $22.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001255 EAP Custom 27001255 Kit Pecutaneous Introduce BOTH IP/OP $276.00 $204.24 $0.00 $220.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $204.85 $204.85 $212.74 $0.00 $57.52 $0.00 $0.00 $0.00 $0.00 $138.00 $218.59 $220.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001256 EAP Custom 27001256 Chest Unit Drainage Pleur BOTH IP/OP $195.00 $144.30 $0.00 $156.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $144.73 $144.73 $150.31 $0.00 $40.64 $0.00 $0.00 $0.00 $0.00 $97.50 $154.44 $156.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001257 EAP Custom 27001257 Bag Pressure 500cc BOTH IP/OP $82.00 $60.68 $0.00 $65.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $60.86 $60.86 $63.21 $0.00 $17.09 $0.00 $0.00 $0.00 $0.00 $41.00 $64.94 $65.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001258 EAP Custom 27001258 Bag Pressure 1000cc BOTH IP/OP $36.00 $26.64 $0.00 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $26.72 $26.72 $27.75 $0.00 $7.50 $0.00 $0.00 $0.00 $0.00 $18.00 $28.51 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001260 EAP Custom 27001260 Tube Feeding Ng 8fr 36in Entri BOTH IP/OP $65.00 $48.10 $0.00 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $48.24 $48.24 $50.10 $0.00 $13.55 $0.00 $0.00 $0.00 $0.00 $32.50 $51.48 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001261 EAP Custom 27001261 Multi Lumen Cvc W/o Silver Su BOTH IP/OP $751.00 $555.74 $0.00 $600.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $557.39 $557.39 $578.87 $0.00 $156.51 $0.00 $0.00 $0.00 $0.00 $375.50 $594.79 $600.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001262 EAP Custom 27001262 Kit Triple Lumen Catheter BOTH IP/OP $697.00 $515.78 $0.00 $557.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $517.31 $517.31 $537.25 $0.00 $145.25 $0.00 $0.00 $0.00 $0.00 $348.50 $552.02 $557.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001263 EAP Custom 27001263 Catheter Swan Ganz BOTH IP/OP $726.00 $537.24 $0.00 $580.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $538.84 $538.84 $559.60 $0.00 $151.30 $0.00 $0.00 $0.00 $0.00 $363.00 $574.99 $580.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001264 EAP Custom 27001264 Delivery System Closed In BOTH IP/OP $141.00 $104.34 $0.00 $112.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $104.65 $104.65 $108.68 $0.00 $29.38 $0.00 $0.00 $0.00 $0.00 $70.50 $111.67 $112.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001265 EAP Custom 27001265 Set T-port Small Bore Ext BOTH IP/OP $14.00 $10.36 $0.00 $11.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $10.39 $10.39 $10.79 $0.00 $2.92 $0.00 $0.00 $0.00 $0.00 $7.00 $11.09 $11.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001268 EAP Custom 27001268 Tray Catheter Urethral 14 BOTH IP/OP $17.00 $12.58 $0.00 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $12.62 $12.62 $13.10 $0.00 $3.54 $0.00 $0.00 $0.00 $0.00 $8.50 $13.46 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001270 EAP Custom 27001270 Tray Foley Preconnected 1 BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001271 EAP Custom 27001271 Tray Foley Perconnected 1 BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001272 EAP Custom 27001272 Tray Thoracentesis Dispos BOTH IP/OP $207.00 $153.18 $0.00 $165.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $153.64 $153.64 $159.56 $0.00 $43.14 $0.00 $0.00 $0.00 $0.00 $103.50 $163.94 $165.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001273 EAP Custom 27001273 Sponges Laparotomy 6522 BOTH IP/OP $119.00 $88.06 $0.00 $95.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $88.32 $88.32 $91.73 $0.00 $24.80 $0.00 $0.00 $0.00 $0.00 $59.50 $94.25 $95.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001274 EAP Custom 27001274 Bovie Pencil Valleylab BOTH IP/OP $34.00 $25.16 $0.00 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $25.23 $25.23 $26.21 $0.00 $7.09 $0.00 $0.00 $0.00 $0.00 $17.00 $26.93 $27.20 $0.00 $22.10 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001283 EAP Custom 27001283 Dressing Acticoat 16x16 BOTH IP/OP $678.00 $501.72 $0.00 $542.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $503.21 $503.21 $522.60 $0.00 $141.30 $0.00 $0.00 $0.00 $0.00 $339.00 $536.98 $542.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001284 EAP Custom 27001284 Kit Vascular Conform BOTH IP/OP $108.00 $79.92 $0.00 $86.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $80.16 $80.16 $83.25 $0.00 $22.51 $0.00 $0.00 $0.00 $0.00 $54.00 $85.54 $86.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001285 EAP Custom 27001285 Sleeve Knee Regular Dvt BOTH IP/OP $388.00 $287.12 $0.00 $310.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $287.97 $287.97 $299.07 $0.00 $80.86 $0.00 $0.00 $0.00 $0.00 $194.00 $307.30 $310.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001286 EAP Custom 27001286 Sleeve Knee X-large Dvt BOTH IP/OP $469.00 $347.06 $0.00 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $348.09 $348.09 $361.51 $0.00 $97.74 $0.00 $0.00 $0.00 $0.00 $234.50 $371.45 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001287 EAP Custom 27001287 Sleeve Thigh Regular Dvt BOTH IP/OP $553.00 $409.22 $0.00 $442.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $410.44 $410.44 $426.25 $0.00 $115.25 $0.00 $0.00 $0.00 $0.00 $276.50 $437.98 $442.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001288 EAP Custom 27001288 Sleeve Thigh X-large Dvt BOTH IP/OP $284.00 $210.16 $0.00 $227.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $210.78 $210.78 $218.91 $0.00 $59.19 $0.00 $0.00 $0.00 $0.00 $142.00 $224.93 $227.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001289 EAP Custom 27001289 1st First Select Overlay BOTH IP/OP $131.00 $96.94 $0.00 $104.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $97.23 $97.23 $100.97 $0.00 $27.30 $0.00 $0.00 $0.00 $0.00 $65.50 $103.75 $104.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001298 EAP Custom 27001298 Therapy For Cvvh/cvvhd 4 BOTH IP/OP $166.00 $122.84 $0.00 $132.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $123.21 $123.21 $127.95 $0.00 $34.59 $0.00 $0.00 $0.00 $0.00 $83.00 $131.47 $132.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001299 EAP Custom 27001299 Dialysis Filter BOTH IP/OP $699.00 $517.26 $0.00 $559.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $518.80 $518.80 $538.79 $0.00 $145.67 $0.00 $0.00 $0.00 $0.00 $349.50 $553.61 $559.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001312 EAP Custom 27001312 Catheter Thoracic 20fr BOTH IP/OP $40.00 $29.60 $0.00 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $20.00 $31.68 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001313 EAP Custom 27001313 Catheter Thoracic 32fr BOTH IP/OP $43.00 $31.82 $0.00 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $31.91 $31.91 $33.14 $0.00 $8.96 $0.00 $0.00 $0.00 $0.00 $21.50 $34.06 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001314 EAP Custom 27001314 Catheter Thoracic 36fr BOTH IP/OP $43.00 $31.82 $0.00 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $31.91 $31.91 $33.14 $0.00 $8.96 $0.00 $0.00 $0.00 $0.00 $21.50 $34.06 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001315 EAP HCPCS C1729 Catheter Foley 5cc 14fr BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $10.32 $10.32 $0.00 $0.00 $0.00 $3.96 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $11.24 $11.24 $0.00 $9.50 $15.05 $15.20 $0.00 $0.00 $0.00 $2.97 $0.00 $0.00 $3.02 $0.00 $0.00 $0.00 $0.00 $0.00 27001316 EAP HCPCS C1729 Catheter Foley 16fr BOTH IP/OP $18.00 $13.32 $0.00 $14.40 $9.77 $9.77 $0.00 $0.00 $0.00 $3.75 $13.36 $13.36 $13.87 $0.00 $3.75 $0.00 $10.65 $10.65 $0.00 $9.00 $14.26 $14.40 $0.00 $0.00 $0.00 $2.82 $0.00 $0.00 $2.87 $0.00 $0.00 $0.00 $0.00 $0.00 27001317 EAP HCPCS C1729 Catheter Foley 5cc 18fr BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $10.32 $10.32 $0.00 $0.00 $0.00 $3.96 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $11.24 $11.24 $0.00 $9.50 $15.05 $15.20 $0.00 $0.00 $0.00 $2.97 $0.00 $0.00 $3.02 $0.00 $0.00 $0.00 $0.00 $0.00 27001318 EAP Custom 27001318 Catheter Ventricular 20cm BOTH IP/OP $683.00 $505.42 $0.00 $546.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $506.92 $506.92 $526.46 $0.00 $142.34 $0.00 $0.00 $0.00 $0.00 $341.50 $540.94 $546.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001319 EAP Custom 27001319 Catheter Edm Ii Becker BOTH IP/OP "$1,339.00 " $990.86 $0.00 "$1,071.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $993.81 $993.81 "$1,032.10" $0.00 $279.05 $0.00 $0.00 $0.00 $0.00 $669.50 "$1,060.49" "$1,071.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001320 EAP Custom 27001320 Artery Arterial Catheriza BOTH IP/OP $47.00 $34.78 $0.00 $37.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $34.88 $34.88 $36.23 $0.00 $9.79 $0.00 $0.00 $0.00 $0.00 $23.50 $37.22 $37.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001321 EAP Custom 27001321 Artery Radial Catherizati BOTH IP/OP $69.00 $51.06 $0.00 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $51.21 $51.21 $53.19 $0.00 $14.38 $0.00 $0.00 $0.00 $0.00 $34.50 $54.65 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001322 EAP Custom 27001322 Tube Salem Sump 48 Lengt BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001323 EAP Custom 27001323 Tube Salem Silicone Size BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001324 EAP Custom 27001324 Tubes Salem Sump 48 Leng BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001328 EAP Custom 27001328 Bag Drainage Becker BOTH IP/OP $202.00 $149.48 $0.00 $161.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $149.92 $149.92 $155.70 $0.00 $42.10 $0.00 $0.00 $0.00 $0.00 $101.00 $159.98 $161.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001329 EAP Custom 27001329 Tray Catheter Insrtn Dulm BOTH IP/OP $937.00 $693.38 $0.00 $749.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $695.44 $695.44 $722.24 $0.00 $195.27 $0.00 $0.00 $0.00 $0.00 $468.50 $742.10 $749.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001330 EAP Custom 27001330 Scapel Surg W/handle Atta BOTH IP/OP $142.00 $105.08 $0.00 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $105.39 $105.39 $109.45 $0.00 $29.59 $0.00 $0.00 $0.00 $0.00 $71.00 $112.46 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001331 EAP Custom 27001331 Triconnector With Valve BOTH IP/OP $17.00 $12.58 $0.00 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $12.62 $12.62 $13.10 $0.00 $3.54 $0.00 $0.00 $0.00 $0.00 $8.50 $13.46 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001337 EAP Custom 27001337 Cable Patient 12 Pin #r53 BOTH IP/OP $300.00 $222.00 $0.00 $240.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $222.66 $222.66 $231.24 $0.00 $62.52 $0.00 $0.00 $0.00 $0.00 $150.00 $237.60 $240.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001341 EAP Custom 27001341 Kit Thoracotomy BOTH IP/OP $217.00 $160.58 $0.00 $173.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $161.06 $161.06 $167.26 $0.00 $45.22 $0.00 $0.00 $0.00 $0.00 $108.50 $171.86 $173.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001347 EAP Custom 27001347 Pouch Fecal Incontinence BOTH IP/OP $52.00 $38.48 $0.00 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $38.59 $38.59 $40.08 $0.00 $10.84 $0.00 $0.00 $0.00 $0.00 $26.00 $41.18 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001348 EAP Custom 27001348 Kit Pressure Monitoring T BOTH IP/OP $177.00 $130.98 $0.00 $141.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $131.37 $131.37 $136.43 $0.00 $36.89 $0.00 $0.00 $0.00 $0.00 $88.50 $140.18 $141.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001349 EAP Custom 27001349 Transducer Disp For Icp BOTH IP/OP $36.00 $26.64 $0.00 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $26.72 $26.72 $27.75 $0.00 $7.50 $0.00 $0.00 $0.00 $0.00 $18.00 $28.51 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001350 EAP Custom 27001350 Bridge Kit Bifurated Resp BOTH IP/OP $120.00 $88.80 $0.00 $96.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $89.06 $89.06 $92.50 $0.00 $25.01 $0.00 $0.00 $0.00 $0.00 $60.00 $95.04 $96.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001351 EAP Custom 27001351 Kit Transducer Monitoring BOTH IP/OP $324.00 $239.76 $0.00 $259.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $240.47 $240.47 $249.74 $0.00 $67.52 $0.00 $0.00 $0.00 $0.00 $162.00 $256.61 $259.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001352 EAP Custom 27001352 Kit Pressure Monitoring BOTH IP/OP $250.00 $185.00 $0.00 $200.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $185.55 $185.55 $192.70 $0.00 $52.10 $0.00 $0.00 $0.00 $0.00 $125.00 $198.00 $200.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001354 EAP Custom 27001354 Bag Feeding Gavage 500ml BOTH IP/OP $28.00 $20.72 $0.00 $22.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $20.78 $20.78 $21.58 $0.00 $5.84 $0.00 $0.00 $0.00 $0.00 $14.00 $22.18 $22.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001355 EAP Custom 27001355 Bag 1000ml Pump Set BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001356 EAP Custom 27001356 Kit Pecutaneous Introduce BOTH IP/OP $129.00 $95.46 $0.00 $103.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $95.74 $95.74 $99.43 $0.00 $26.88 $0.00 $0.00 $0.00 $0.00 $64.50 $102.17 $103.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001357 EAP Custom 27001357 Chest Unit Drainage Pleur BOTH IP/OP $455.00 $336.70 $0.00 $364.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $337.70 $337.70 $350.71 $0.00 $94.82 $0.00 $0.00 $0.00 $0.00 $227.50 $360.36 $364.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001358 EAP Custom 27001358 Chest Imot Dry Suction Sy BOTH IP/OP $316.00 $233.84 $0.00 $252.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $234.54 $234.54 $243.57 $0.00 $65.85 $0.00 $0.00 $0.00 $0.00 $158.00 $250.27 $252.80 $0.00 $205.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001363 EAP Custom 27001363 Trac Dressing Xl BOTH IP/OP $157.00 $116.18 $0.00 $125.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $116.53 $116.53 $121.02 $0.00 $32.72 $0.00 $0.00 $0.00 $0.00 $78.50 $124.34 $125.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001366 EAP Custom 27001366 Tube Feeding Ng 8fr 36in Entr BOTH IP/OP $65.00 $48.10 $0.00 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $48.24 $48.24 $50.10 $0.00 $13.55 $0.00 $0.00 $0.00 $0.00 $32.50 $51.48 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001367 EAP Custom 27001367 Kit Triple Lumen Catheter BOTH IP/OP $697.00 $515.78 $0.00 $557.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $517.31 $517.31 $537.25 $0.00 $145.25 $0.00 $0.00 $0.00 $0.00 $348.50 $552.02 $557.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001369 EAP Custom 27001369 Kit Monitoring Intracrani BOTH IP/OP $460.00 $340.40 $0.00 $368.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $341.41 $341.41 $354.57 $0.00 $95.86 $0.00 $0.00 $0.00 $0.00 $230.00 $364.32 $368.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001370 EAP Custom 27001370 Catheter Swan Ganz BOTH IP/OP $674.00 $498.76 $0.00 $539.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $500.24 $500.24 $519.52 $0.00 $140.46 $0.00 $0.00 $0.00 $0.00 $337.00 $533.81 $539.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001371 EAP Custom 27001371 Delivery System Closed In BOTH IP/OP $152.00 $112.48 $0.00 $121.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $112.81 $112.81 $117.16 $0.00 $31.68 $0.00 $0.00 $0.00 $0.00 $76.00 $120.38 $121.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001372 EAP Custom 27001372 Probe V-pacing BOTH IP/OP "$1,403.00 " "$1,038.22" $0.00 "$1,122.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,041.31" "$1,041.31" "$1,081.43" $0.00 $292.39 $0.00 $0.00 $0.00 $0.00 $701.50 "$1,111.18" "$1,122.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001374 EAP Custom 27001374 Filter Set 0.22 Micron BOTH IP/OP $20.00 $14.80 $0.00 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.84 $14.84 $15.42 $0.00 $4.17 $0.00 $0.00 $0.00 $0.00 $10.00 $15.84 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001376 EAP Custom 27001376 Tray Foley Perconnected 1 BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001377 EAP Custom 27001377 Kit Ventriculostomy BOTH IP/OP "$1,782.00 " "$1,318.68" $0.00 "$1,425.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,322.60" "$1,322.60" "$1,373.57" $0.00 $371.37 $0.00 $0.00 $0.00 $0.00 $891.00 "$1,411.34" "$1,425.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001379 EAP Custom 27001379 Tray Pericardiocentesis BOTH IP/OP "$1,235.00 " $913.90 $0.00 $988.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $916.62 $916.62 $951.94 $0.00 $257.37 $0.00 $0.00 $0.00 $0.00 $617.50 $978.12 $988.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001380 EAP Custom 27001380 Central Line Dressing Tray With Biopatch BOTH IP/OP $47.00 $34.78 $0.00 $37.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $34.88 $34.88 $36.23 $0.00 $9.79 $0.00 $0.00 $0.00 $0.00 $23.50 $37.22 $37.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001391 EAP Custom 27001391 .014 Nitrex Guidewire BOTH IP/OP "$2,554.00 " "$1,889.96" $0.00 "$2,043.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,895.58" "$1,895.58" "$1,968.62" $0.00 $532.25 $0.00 $0.00 $0.00 $0.00 "$1,277.00" "$2,022.77" "$2,043.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001392 EAP Custom 27001392 Sleeve Knee Regular Dvt BOTH IP/OP $388.00 $287.12 $0.00 $310.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $287.97 $287.97 $299.07 $0.00 $80.86 $0.00 $0.00 $0.00 $0.00 $194.00 $307.30 $310.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001393 EAP Custom 27001393 Sleeve Knee X-large Dvt BOTH IP/OP $469.00 $347.06 $0.00 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $348.09 $348.09 $361.51 $0.00 $97.74 $0.00 $0.00 $0.00 $0.00 $234.50 $371.45 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001394 EAP Custom 27001394 Sleeve Thigh Regular Dvt BOTH IP/OP $553.00 $409.22 $0.00 $442.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $410.44 $410.44 $426.25 $0.00 $115.25 $0.00 $0.00 $0.00 $0.00 $276.50 $437.98 $442.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001395 EAP Custom 27001395 Sleeve Thigh X-large Dvt BOTH IP/OP $616.00 $455.84 $0.00 $492.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $457.20 $457.20 $474.81 $0.00 $128.37 $0.00 $0.00 $0.00 $0.00 $308.00 $487.87 $492.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001399 EAP Custom 27001399 Tray Circumcision BOTH IP/OP $65.00 $48.10 $0.00 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $48.24 $48.24 $50.10 $0.00 $13.55 $0.00 $0.00 $0.00 $0.00 $32.50 $51.48 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001400 EAP Custom 27001400 Needle Neo-natal Lumbar P BOTH IP/OP $21.00 $15.54 $0.00 $16.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $15.59 $15.59 $16.19 $0.00 $4.38 $0.00 $0.00 $0.00 $0.00 $10.50 $16.63 $16.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001401 EAP Custom 27001401 Tubes Capillary Hepariniz BOTH IP/OP $150.00 $111.00 $0.00 $120.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $111.33 $111.33 $115.62 $0.00 $31.26 $0.00 $0.00 $0.00 $0.00 $75.00 $118.80 $120.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001403 EAP Custom 27001403 Tube Feeding Plastic 8fr BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001408 EAP Custom 27001408 Bag Feeding Gavage 500ml BOTH IP/OP $14.00 $10.36 $0.00 $11.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $10.39 $10.39 $10.79 $0.00 $2.92 $0.00 $0.00 $0.00 $0.00 $7.00 $11.09 $11.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001409 EAP Custom 27001409 Set Breast Pump Complete BOTH IP/OP $71.00 $52.54 $0.00 $56.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $52.70 $52.70 $54.73 $0.00 $14.80 $0.00 $0.00 $0.00 $0.00 $35.50 $56.23 $56.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001410 EAP Custom 27001410 Cassettes Imed #9260 20/c BOTH IP/OP $16.00 $11.84 $0.00 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $8.00 $12.67 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001411 EAP Custom 27001411 Catheter Quick Iv 22ga BOTH IP/OP $7.00 $5.18 $0.00 $5.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $5.20 $5.20 $5.40 $0.00 $1.46 $0.00 $0.00 $0.00 $0.00 $3.50 $5.54 $5.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001412 EAP Custom 27001412 Filter Set 0.22 Micron BOTH IP/OP $15.00 $11.10 $0.00 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.13 $11.13 $11.56 $0.00 $3.13 $0.00 $0.00 $0.00 $0.00 $7.50 $11.88 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001413 EAP Custom 27001413 Set T-port Small Bore Ext BOTH IP/OP $14.00 $10.36 $0.00 $11.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $10.39 $10.39 $10.79 $0.00 $2.92 $0.00 $0.00 $0.00 $0.00 $7.00 $11.09 $11.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001415 EAP Custom 27001415 Tube Sump Gastric 50/cs BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $0.00 $0.00 $0.00 $9.50 $15.05 $15.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001418 EAP Custom 27001418 Precision Introd.26g(1.9f) BOTH IP/OP $149.00 $110.26 $0.00 $119.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $110.59 $110.59 $114.85 $0.00 $31.05 $0.00 $0.00 $0.00 $0.00 $74.50 $118.01 $119.20 $0.00 $96.85 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001419 EAP Custom 27001419 26g Catheter(1.9f 1st Picc Bd) BOTH IP/OP $260.00 $192.40 $0.00 $208.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $192.97 $192.97 $200.41 $0.00 $54.18 $0.00 $0.00 $0.00 $0.00 $130.00 $205.92 $208.00 $0.00 $169.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001420 EAP Custom 27001420 Picc Tray (bd Procedure Tray) BOTH IP/OP $219.00 $162.06 $0.00 $175.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $162.54 $162.54 $168.81 $0.00 $45.64 $0.00 $0.00 $0.00 $0.00 $109.50 $173.45 $175.20 $0.00 $142.35 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001421 EAP Custom 27001421 Precision Introducer 22g(2.8f) BOTH IP/OP $183.00 $135.42 $0.00 $146.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $135.82 $135.82 $141.06 $0.00 $38.14 $0.00 $0.00 $0.00 $0.00 $91.50 $144.94 $146.40 $0.00 $118.95 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001422 EAP Custom 27001422 22g Catheter(2.8f 1st Picc Bd) BOTH IP/OP $343.00 $253.82 $0.00 $274.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $254.57 $254.57 $264.38 $0.00 $71.48 $0.00 $0.00 $0.00 $0.00 $171.50 $271.66 $274.40 $0.00 $222.95 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001423 EAP Custom 27001423 Argyle Picc 1.9frx39cm Dual Lu BOTH IP/OP $423.00 $313.02 $0.00 $338.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $313.95 $313.95 $326.05 $0.00 $88.15 $0.00 $0.00 $0.00 $0.00 $211.50 $335.02 $338.40 $0.00 $274.95 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001424 EAP Custom 27001424 20g(3fr)bdl Cath Picc Dual Lum BOTH IP/OP $154.00 $113.96 $0.00 $123.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $114.30 $114.30 $118.70 $0.00 $32.09 $0.00 $0.00 $0.00 $0.00 $77.00 $121.97 $123.20 $0.00 $100.10 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001428 EAP Custom 27001428 Tray Circumcision BOTH IP/OP $30.00 $22.20 $0.00 $24.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $22.27 $22.27 $23.12 $0.00 $6.25 $0.00 $0.00 $0.00 $0.00 $15.00 $23.76 $24.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001429 EAP Custom 27001429 Needle Neo-natal Lumbar P BOTH IP/OP $21.00 $15.54 $0.00 $16.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $15.59 $15.59 $16.19 $0.00 $4.38 $0.00 $0.00 $0.00 $0.00 $10.50 $16.63 $16.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001430 EAP Custom 27001430 Needle Spinal 22g 25/bx BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001431 EAP Custom 27001431 Tubes Capillary Hepariniz BOTH IP/OP $150.00 $111.00 $0.00 $120.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $111.33 $111.33 $115.62 $0.00 $31.26 $0.00 $0.00 $0.00 $0.00 $75.00 $118.80 $120.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001432 EAP Custom 27001432 Tube Nasogastric Feeding BOTH IP/OP $91.00 $67.34 $0.00 $72.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $67.54 $67.54 $70.14 $0.00 $18.96 $0.00 $0.00 $0.00 $0.00 $45.50 $72.07 $72.80 $0.00 $59.15 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001435 EAP Custom 27001435 Catheter Urethral 8fr BOTH IP/OP $15.00 $11.10 $0.00 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.13 $11.13 $11.56 $0.00 $3.13 $0.00 $0.00 $0.00 $0.00 $7.50 $11.88 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001436 EAP Custom 27001436 Catheter Umbilical 15 3- BOTH IP/OP $49.00 $36.26 $0.00 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $36.37 $36.37 $37.77 $0.00 $10.21 $0.00 $0.00 $0.00 $0.00 $24.50 $38.81 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001437 EAP Custom 27001437 Catheter Umbilical 15 5f BOTH IP/OP $63.00 $46.62 $0.00 $50.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $46.76 $46.76 $48.56 $0.00 $13.13 $0.00 $0.00 $0.00 $0.00 $31.50 $49.90 $50.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001438 EAP Custom 27001438 Tube Feeding Plastic 8fr BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001441 EAP Custom 27001441 Scapel Surg W/handle Atta BOTH IP/OP $142.00 $105.08 $0.00 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $105.39 $105.39 $109.45 $0.00 $29.59 $0.00 $0.00 $0.00 $0.00 $71.00 $112.46 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001443 EAP Custom 27001443 Pouch Little Ones Cut To BOTH IP/OP $6.00 $4.44 $0.00 $4.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $4.45 $4.45 $4.62 $0.00 $1.25 $0.00 $0.00 $0.00 $0.00 $3.00 $4.75 $4.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001446 EAP Custom 27001446 Transducer With Interg 43 BOTH IP/OP $37.00 $27.38 $0.00 $29.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $27.46 $27.46 $28.52 $0.00 $7.71 $0.00 $0.00 $0.00 $0.00 $18.50 $29.30 $29.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001447 EAP Custom 27001447 Bag 1000ml Pump Set BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001448 EAP Custom 27001448 Catheter Thoracic Trocar BOTH IP/OP $134.00 $99.16 $0.00 $107.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $67.00 $106.13 $107.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001449 EAP Custom 27001449 Catheter Thoracic Trocar 10 F BOTH IP/OP $177.00 $130.98 $0.00 $141.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $131.37 $131.37 $136.43 $0.00 $36.89 $0.00 $0.00 $0.00 $0.00 $88.50 $140.18 $141.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001450 EAP Custom 27001450 Chest Unit Drainage Pleur BOTH IP/OP $161.00 $119.14 $0.00 $128.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $119.49 $119.49 $124.10 $0.00 $33.55 $0.00 $0.00 $0.00 $0.00 $80.50 $127.51 $128.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001451 EAP Custom 27001451 Cassettes Imed #9260 20/c BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001452 EAP Custom 27001452 Catheter Quick Iv 22gax1- BOTH IP/OP $3.00 $2.22 $0.00 $2.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $2.23 $2.23 $2.31 $0.00 $0.63 $0.00 $0.00 $0.00 $0.00 $1.50 $2.38 $2.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001453 EAP Custom 27001453 Catheter Introducer Steri BOTH IP/OP $3.00 $2.22 $0.00 $2.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $2.23 $2.23 $2.31 $0.00 $0.63 $0.00 $0.00 $0.00 $0.00 $1.50 $2.38 $2.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001454 EAP Custom 27001454 Filter Set 0.22 Micron BOTH IP/OP $20.00 $14.80 $0.00 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.84 $14.84 $15.42 $0.00 $4.17 $0.00 $0.00 $0.00 $0.00 $10.00 $15.84 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001455 EAP Custom 27001455 Set T-port Small Bore Ext BOTH IP/OP $14.00 $10.36 $0.00 $11.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $10.39 $10.39 $10.79 $0.00 $2.92 $0.00 $0.00 $0.00 $0.00 $7.00 $11.09 $11.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001456 EAP Custom 27001456 Tray Transfusion Sterile BOTH IP/OP $597.00 $441.78 $0.00 $477.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $443.09 $443.09 $460.17 $0.00 $124.41 $0.00 $0.00 $0.00 $0.00 $298.50 $472.82 $477.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001458 EAP Custom 27001458 Tube Sump Gastric 50/cs BOTH IP/OP $44.00 $32.56 $0.00 $35.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $32.66 $32.66 $33.92 $0.00 $9.17 $0.00 $0.00 $0.00 $0.00 $22.00 $34.85 $35.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001459 EAP HCPCS C1751 Catheter Iv 26g 120/cs BOTH IP/OP $28.00 $20.72 $0.00 $22.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.00 $22.18 $22.40 $0.00 $0.00 $0.00 $4.38 $0.00 $0.00 $4.46 $0.00 $0.00 $0.00 $0.00 $0.00 27001466 EAP Custom 27001466 Catheter Suction 5fr Ster BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001468 EAP Custom 27001468 Catheter Suction Plastic 14 BOTH IP/OP $3.00 $2.22 $0.00 $2.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $1.50 $2.38 $2.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001469 EAP Custom 27001469 Catheter Urethral Two-eye BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001471 EAP Custom 27001471 Set Urinary Drain W/conta BOTH IP/OP $20.00 $14.80 $0.00 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.84 $14.84 $15.42 $0.00 $4.17 $0.00 $0.00 $0.00 $0.00 $10.00 $15.84 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001473 EAP Custom 27001473 Scaple Surg W/handle Atta BOTH IP/OP $142.00 $105.08 $0.00 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $105.39 $105.39 $109.45 $0.00 $29.59 $0.00 $0.00 $0.00 $0.00 $71.00 $112.46 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001475 EAP Custom 27001475 Stapler Skin Disposable 3 BOTH IP/OP $87.00 $64.38 $0.00 $69.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $64.57 $64.57 $67.06 $0.00 $18.13 $0.00 $0.00 $0.00 $0.00 $43.50 $68.90 $69.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001486 EAP Custom 27001486 Speculum Pediatric BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001487 EAP Custom 27001487 Bag Hyperinflation BOTH IP/OP $85.00 $62.90 $0.00 $68.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $63.09 $63.09 $65.52 $0.00 $17.71 $0.00 $0.00 $0.00 $0.00 $42.50 $67.32 $68.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001490 EAP Custom 27001490 Tray Catheter Urethral 14 BOTH IP/OP $17.00 $12.58 $0.00 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $12.62 $12.62 $13.10 $0.00 $3.54 $0.00 $0.00 $0.00 $0.00 $8.50 $13.46 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001492 EAP Custom 27001492 Tray Foley Preconnected 1 BOTH IP/OP $51.00 $37.74 $0.00 $40.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $37.85 $37.85 $39.31 $0.00 $10.63 $0.00 $0.00 $0.00 $0.00 $25.50 $40.39 $40.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001494 EAP Custom 27001494 Sponges Laparotomy 6522 BOTH IP/OP $17.00 $12.58 $0.00 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $12.62 $12.62 $13.10 $0.00 $3.54 $0.00 $0.00 $0.00 $0.00 $8.50 $13.46 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001501 EAP Custom 27001501 Sleeve Knee Regular Dvt BOTH IP/OP $388.00 $287.12 $0.00 $310.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $287.97 $287.97 $299.07 $0.00 $80.86 $0.00 $0.00 $0.00 $0.00 $194.00 $307.30 $310.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001502 EAP Custom 27001502 Sleeve Knee X-large Dvt BOTH IP/OP $469.00 $347.06 $0.00 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $348.09 $348.09 $361.51 $0.00 $97.74 $0.00 $0.00 $0.00 $0.00 $234.50 $371.45 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001503 EAP Custom 27001503 Sleeve Thigh Regular Dvt BOTH IP/OP $238.00 $176.12 $0.00 $190.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $176.64 $176.64 $183.45 $0.00 $49.60 $0.00 $0.00 $0.00 $0.00 $119.00 $188.50 $190.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001618 EAP Custom 27001618 Triadyne Ii (bed) BOTH IP/OP $737.00 $545.38 $0.00 $589.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $547.00 $547.00 $568.08 $0.00 $153.59 $0.00 $0.00 $0.00 $0.00 $368.50 $583.70 $589.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001620 EAP Custom 27001620 Fluidair Elite (bed) BOTH IP/OP $772.00 $571.28 $0.00 $617.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $572.98 $572.98 $595.06 $0.00 $160.88 $0.00 $0.00 $0.00 $0.00 $386.00 $611.42 $617.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001635 EAP Custom 27001635 Tube Salem Sump 48 Lengt BOTH IP/OP $36.00 $26.64 $0.00 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $26.72 $26.72 $27.75 $0.00 $7.50 $0.00 $0.00 $0.00 $0.00 $18.00 $28.51 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001636 EAP Custom 27001636 Set Urinary Drain W/conta BOTH IP/OP $20.00 $14.80 $0.00 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.84 $14.84 $15.42 $0.00 $4.17 $0.00 $0.00 $0.00 $0.00 $10.00 $15.84 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001641 EAP Custom 27001641 Tray Douch Disposable BOTH IP/OP $69.00 $51.06 $0.00 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $51.21 $51.21 $53.19 $0.00 $14.38 $0.00 $0.00 $0.00 $0.00 $34.50 $54.65 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001644 EAP Custom 27001644 Tray Foley Preconnected 1 BOTH IP/OP $52.00 $38.48 $0.00 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $38.59 $38.59 $40.08 $0.00 $10.84 $0.00 $0.00 $0.00 $0.00 $26.00 $41.18 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001645 EAP Custom 27001645 Tray Foley Perconnected 1 BOTH IP/OP $52.00 $38.48 $0.00 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $38.59 $38.59 $40.08 $0.00 $10.84 $0.00 $0.00 $0.00 $0.00 $26.00 $41.18 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001647 EAP Custom 27001647 Arrow Super/extreme Cath Kit BOTH IP/OP $802.00 $593.48 $0.00 $641.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $595.24 $595.24 $618.18 $0.00 $167.14 $0.00 $0.00 $0.00 $0.00 $401.00 $635.18 $641.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001649 EAP Custom 27001649 Central Line Dressing Tray BOTH IP/OP $34.00 $25.16 $0.00 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $25.23 $25.23 $26.21 $0.00 $7.09 $0.00 $0.00 $0.00 $0.00 $17.00 $26.93 $27.20 $0.00 $22.10 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001650 EAP Custom 27001650 Continuous Cardiac O/put Swans BOTH IP/OP $604.00 $446.96 $0.00 $483.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $448.29 $448.29 $465.56 $0.00 $125.87 $0.00 $0.00 $0.00 $0.00 $302.00 $478.37 $483.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001652 EAP Custom 27001652 Pressure Transclucer Kits BOTH IP/OP $329.00 $243.46 $0.00 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $244.18 $244.18 $253.59 $0.00 $68.56 $0.00 $0.00 $0.00 $0.00 $164.50 $260.57 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001653 EAP Custom 27001653 Percutaneous Introducer Kits BOTH IP/OP "$2,364.00 " "$1,749.36" $0.00 "$1,891.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,754.56" "$1,754.56" "$1,822.17" $0.00 $492.66 $0.00 $0.00 $0.00 $0.00 "$1,182.00" "$1,872.29" "$1,891.20" $0.00 "$1,536.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001655 EAP Custom 27001655 Sutures BOTH IP/OP $211.00 $156.14 $0.00 $168.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $156.60 $156.60 $162.64 $0.00 $43.97 $0.00 $0.00 $0.00 $0.00 $105.50 $167.11 $168.80 $0.00 $137.15 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001657 EAP Custom 27001657 Swan Ganz Catheters BOTH IP/OP $604.00 $446.96 $0.00 $483.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $448.29 $448.29 $465.56 $0.00 $125.87 $0.00 $0.00 $0.00 $0.00 $302.00 $478.37 $483.20 $0.00 $392.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001658 EAP Custom 27001658 Guidewire .35x.68cm BOTH IP/OP $64.00 $47.36 $0.00 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $47.50 $47.50 $49.33 $0.00 $13.34 $0.00 $0.00 $0.00 $0.00 $32.00 $50.69 $51.20 $0.00 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001660 EAP Custom 27001660 Huber Needle BOTH IP/OP $17.00 $12.58 $0.00 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $12.62 $12.62 $13.10 $0.00 $3.54 $0.00 $0.00 $0.00 $0.00 $8.50 $13.46 $13.60 $0.00 $11.05 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001665 EAP Custom 27001665 14fx15cm Schon Xl Dbl Lmn Vasc BOTH IP/OP "$6,497.00 " "$4,807.78" $0.00 "$5,197.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,007.89" $0.00 "$1,353.97" $0.00 $0.00 $0.00 $0.00 "$3,248.50" "$5,145.62" "$5,197.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001666 EAP Custom 27001666 14fx24cm Schon Xl Dbl Lmn Vasc BOTH IP/OP "$6,497.00 " "$4,807.78" $0.00 "$5,197.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,007.89" $0.00 "$1,353.97" $0.00 $0.00 $0.00 $0.00 "$3,248.50" "$5,145.62" "$5,197.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001667 EAP Custom 27001667 14fx20cm Schon Xl Dbl Lmn Vasc BOTH IP/OP "$6,497.00 " "$4,807.78" $0.00 "$5,197.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,007.89" $0.00 "$1,353.97" $0.00 $0.00 $0.00 $0.00 "$3,248.50" "$5,145.62" "$5,197.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001670 EAP Custom 27001670 Twist Lock Cath Gard Catheter BOTH IP/OP $80.00 $59.20 $0.00 $64.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $59.38 $59.38 $61.66 $0.00 $16.67 $0.00 $0.00 $0.00 $0.00 $40.00 $63.36 $64.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001671 EAP Custom 27001671 Needles 18 Ga/7cm (cook) BOTH IP/OP $30.00 $22.20 $0.00 $24.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $22.27 $22.27 $23.12 $0.00 $6.25 $0.00 $0.00 $0.00 $0.00 $15.00 $23.76 $24.00 $0.00 $19.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001672 EAP Custom 27001672 Cook Tlc Tray BOTH IP/OP $457.00 $338.18 $0.00 $365.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $339.19 $339.19 $352.26 $0.00 $95.24 $0.00 $0.00 $0.00 $0.00 $228.50 $361.94 $365.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001675 EAP Custom 27001675 Tubes Extension Plain Pla BOTH IP/OP $5.00 $3.70 $0.00 $4.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $3.71 $3.71 $3.85 $0.00 $1.04 $0.00 $0.00 $0.00 $0.00 $2.50 $3.96 $4.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001679 EAP Custom 27001679 Meter Astech Peak Flow BOTH IP/OP $94.00 $69.56 $0.00 $75.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $69.77 $69.77 $72.46 $0.00 $19.59 $0.00 $0.00 $0.00 $0.00 $47.00 $74.45 $75.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001692 EAP Custom 27001692 Catheter Thoracic 28fr BOTH IP/OP $40.00 $29.60 $0.00 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $20.00 $31.68 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001693 EAP Custom 27001693 Catheter Thoracic 32fr BOTH IP/OP $43.00 $31.82 $0.00 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $31.91 $31.91 $33.14 $0.00 $8.96 $0.00 $0.00 $0.00 $0.00 $21.50 $34.06 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001694 EAP Custom 27001694 Catheter Thoracic 36fr BOTH IP/OP $43.00 $31.82 $0.00 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $31.91 $31.91 $33.14 $0.00 $8.96 $0.00 $0.00 $0.00 $0.00 $21.50 $34.06 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001695 EAP HCPCS C1729 Catheter Foley 5cc 14fr BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $10.32 $10.32 $0.00 $0.00 $0.00 $3.96 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $11.24 $11.24 $0.00 $9.50 $15.05 $15.20 $0.00 $0.00 $0.00 $2.97 $0.00 $0.00 $3.02 $0.00 $0.00 $0.00 $0.00 $0.00 27001696 EAP HCPCS C1729 Catheter Coude Size 14fr BOTH IP/OP $109.00 $80.66 $0.00 $87.20 $59.19 $59.19 $0.00 $0.00 $0.00 $22.72 $80.90 $80.90 $84.02 $0.00 $22.72 $0.00 $64.47 $64.47 $0.00 $54.50 $86.33 $87.20 $0.00 $0.00 $0.00 $17.06 $0.00 $0.00 $17.35 $0.00 $0.00 $0.00 $0.00 $0.00 27001697 EAP HCPCS C1729 Catheter Coude Size 16fr BOTH IP/OP $109.00 $80.66 $0.00 $87.20 $59.19 $59.19 $0.00 $0.00 $0.00 $22.72 $80.90 $80.90 $84.02 $0.00 $22.72 $0.00 $64.47 $64.47 $0.00 $54.50 $86.33 $87.20 $0.00 $0.00 $0.00 $17.06 $0.00 $0.00 $17.35 $0.00 $0.00 $0.00 $0.00 $0.00 27001698 EAP Custom 27001698 Artery Arterial Catheriza BOTH IP/OP $102.00 $75.48 $0.00 $81.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $75.70 $75.70 $78.62 $0.00 $21.26 $0.00 $0.00 $0.00 $0.00 $51.00 $80.78 $81.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001699 EAP Custom 27001699 Artery Radial Catherizati BOTH IP/OP $69.00 $51.06 $0.00 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $51.21 $51.21 $53.19 $0.00 $14.38 $0.00 $0.00 $0.00 $0.00 $34.50 $54.65 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001700 EAP Custom 27001700 Tube Salem Sump 48 Lengt BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001701 EAP Custom 27001701 Tube Salem Silicone Size BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001702 EAP Custom 27001702 Tubes Salem Sump 48 Leng BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001703 EAP Custom 27001703 Kit Tracheotomy Care Ster BOTH IP/OP $30.00 $22.20 $0.00 $24.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $22.27 $22.27 $23.12 $0.00 $6.25 $0.00 $0.00 $0.00 $0.00 $15.00 $23.76 $24.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001706 EAP Custom 27001706 Tray Catheter Insrtn Dulm BOTH IP/OP "$1,009.00 " $746.66 $0.00 $807.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $748.88 $748.88 $777.74 $0.00 $210.28 $0.00 $0.00 $0.00 $0.00 $504.50 $799.13 $807.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001707 EAP Custom 27001707 Scapel Surg W/handle Attached BOTH IP/OP $142.00 $105.08 $0.00 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $105.39 $105.39 $109.45 $0.00 $29.59 $0.00 $0.00 $0.00 $0.00 $71.00 $112.46 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001709 EAP Custom 27001709 Triconnector With Valve BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001713 EAP Custom 27001713 Pouch Active Life Squib Drain BOTH IP/OP $17.00 $12.58 $0.00 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $12.62 $12.62 $13.10 $0.00 $3.54 $0.00 $0.00 $0.00 $0.00 $8.50 $13.46 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001715 EAP Custom 27001715 Cable Patient 12 Pin #r53 BOTH IP/OP $300.00 $222.00 $0.00 $240.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $222.66 $222.66 $231.24 $0.00 $62.52 $0.00 $0.00 $0.00 $0.00 $150.00 $237.60 $240.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001716 EAP Custom 27001716 Electrodes Operative BOTH IP/OP $122.00 $90.28 $0.00 $97.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $90.55 $90.55 $94.04 $0.00 $25.42 $0.00 $0.00 $0.00 $0.00 $61.00 $96.62 $97.60 $0.00 $79.30 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001721 EAP Custom 27001721 Pouch Fecal Incontinence BOTH IP/OP $52.00 $38.48 $0.00 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $38.59 $38.59 $40.08 $0.00 $10.84 $0.00 $0.00 $0.00 $0.00 $26.00 $41.18 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001722 EAP Custom 27001722 Kit Pressure Monitoring T BOTH IP/OP $177.00 $130.98 $0.00 $141.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $131.37 $131.37 $136.43 $0.00 $36.89 $0.00 $0.00 $0.00 $0.00 $88.50 $140.18 $141.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001723 EAP Custom 27001723 Kit Pressure Monitoring BOTH IP/OP $250.00 $185.00 $0.00 $200.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $185.55 $185.55 $192.70 $0.00 $52.10 $0.00 $0.00 $0.00 $0.00 $125.00 $198.00 $200.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001725 EAP Custom 27001725 Bag 1000ml Pump Set BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001726 EAP Custom 27001726 Needle Port-cath 20ga X 1 BOTH IP/OP $16.00 $11.84 $0.00 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.88 $11.88 $12.33 $0.00 $3.33 $0.00 $0.00 $0.00 $0.00 $8.00 $12.67 $12.80 $0.00 $10.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001727 EAP Custom 27001727 Chest Unit Drainage Pleur BOTH IP/OP $455.00 $336.70 $0.00 $364.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $337.70 $337.70 $350.71 $0.00 $94.82 $0.00 $0.00 $0.00 $0.00 $227.50 $360.36 $364.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001732 EAP Custom 27001732 Dressing X-large BOTH IP/OP $697.00 $515.78 $0.00 $557.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $517.31 $517.31 $537.25 $0.00 $145.25 $0.00 $0.00 $0.00 $0.00 $348.50 $552.02 $557.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001733 EAP Custom 27001733 Trac Dressing Xl BOTH IP/OP $157.00 $116.18 $0.00 $125.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $116.53 $116.53 $121.02 $0.00 $32.72 $0.00 $0.00 $0.00 $0.00 $78.50 $124.34 $125.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001735 EAP Custom 27001735 Tube Feeding Ng 8fr 36in Entri BOTH IP/OP $65.00 $48.10 $0.00 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $48.24 $48.24 $50.10 $0.00 $13.55 $0.00 $0.00 $0.00 $0.00 $32.50 $51.48 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001736 EAP Custom 27001736 Kit Triple Lumen Catheter BOTH IP/OP $697.00 $515.78 $0.00 $557.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $517.31 $517.31 $537.25 $0.00 $145.25 $0.00 $0.00 $0.00 $0.00 $348.50 $552.02 $557.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001740 EAP Custom 27001740 Tube Trach #8 Dct BOTH IP/OP $335.00 $247.90 $0.00 $268.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $248.64 $248.64 $258.22 $0.00 $69.81 $0.00 $0.00 $0.00 $0.00 $167.50 $265.32 $268.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001741 EAP Custom 27001741 Tube Trach #6 Dct BOTH IP/OP $335.00 $247.90 $0.00 $268.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $248.64 $248.64 $258.22 $0.00 $69.81 $0.00 $0.00 $0.00 $0.00 $167.50 $265.32 $268.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001742 EAP Custom 27001742 Tube Trach #10 Dct BOTH IP/OP $335.00 $247.90 $0.00 $268.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $248.64 $248.64 $258.22 $0.00 $69.81 $0.00 $0.00 $0.00 $0.00 $167.50 $265.32 $268.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001743 EAP Custom 27001743 Tube Tracheostomy 4-dcfs BOTH IP/OP $326.00 $241.24 $0.00 $260.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $241.96 $241.96 $251.28 $0.00 $67.94 $0.00 $0.00 $0.00 $0.00 $163.00 $258.19 $260.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001744 EAP Custom 27001744 Filter Set 0.22 Micron BOTH IP/OP $20.00 $14.80 $0.00 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.84 $14.84 $15.42 $0.00 $4.17 $0.00 $0.00 $0.00 $0.00 $10.00 $15.84 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001746 EAP Custom 27001746 Tray Foley Preconnected 1 BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001747 EAP Custom 27001747 Tray Foley Perconnected 1 BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001748 EAP Custom 27001748 Tray Thoracentesis Dispos BOTH IP/OP $101.00 $74.74 $0.00 $80.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $74.96 $74.96 $77.85 $0.00 $21.05 $0.00 $0.00 $0.00 $0.00 $50.50 $79.99 $80.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001763 EAP Custom 27001763 Sleeve Knee Regular Dvt BOTH IP/OP $388.00 $287.12 $0.00 $310.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $287.97 $287.97 $299.07 $0.00 $80.86 $0.00 $0.00 $0.00 $0.00 $194.00 $307.30 $310.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001764 EAP Custom 27001764 Sleeve Knee X-large Dvt BOTH IP/OP $469.00 $347.06 $0.00 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $348.09 $348.09 $361.51 $0.00 $97.74 $0.00 $0.00 $0.00 $0.00 $234.50 $371.45 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001765 EAP Custom 27001765 Sleeve Thigh Regular Dvt BOTH IP/OP $238.00 $176.12 $0.00 $190.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $176.64 $176.64 $183.45 $0.00 $49.60 $0.00 $0.00 $0.00 $0.00 $119.00 $188.50 $190.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001766 EAP Custom 27001766 Sleeve Thigh X-large Dvt BOTH IP/OP $284.00 $210.16 $0.00 $227.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $210.78 $210.78 $218.91 $0.00 $59.19 $0.00 $0.00 $0.00 $0.00 $142.00 $224.93 $227.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001768 EAP HCPCS A4300 Temporary Ven Cath Removal BOTH IP/OP $438.00 $324.12 $0.00 $350.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $325.08 $325.08 $337.61 $0.00 $91.28 $0.00 $0.00 $0.00 $0.00 $219.00 $346.90 $350.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001769 EAP Custom 27001769 Tray Catheter Insrtn Dulm BOTH IP/OP "$1,048.00 " $775.52 $0.00 $838.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $777.83 $777.83 $807.80 $0.00 $218.40 $0.00 $0.00 $0.00 $0.00 $524.00 $830.02 $838.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001770 EAP Custom 27001770 Central Line Dressing Tray BOTH IP/OP $47.00 $34.78 $0.00 $37.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $34.88 $34.88 $36.23 $0.00 $9.79 $0.00 $0.00 $0.00 $0.00 $23.50 $37.22 $37.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001771 EAP Custom 27001771 Catheter Repair Kit BOTH IP/OP $803.00 $594.22 $0.00 $642.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $595.99 $595.99 $618.95 $0.00 $167.35 $0.00 $0.00 $0.00 $0.00 $401.50 $635.98 $642.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001773 EAP Custom 27001773 Occult Blood Supply BOTH IP/OP $40.00 $29.60 $0.00 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $29.69 $29.69 $30.83 $0.00 $8.34 $0.00 $0.00 $0.00 $0.00 $20.00 $31.68 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001778 EAP Custom 27001778 Needle Port-cath 20ga X 1 BOTH IP/OP $36.00 $26.64 $0.00 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $26.72 $26.72 $27.75 $0.00 $7.50 $0.00 $0.00 $0.00 $0.00 $18.00 $28.51 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001779 EAP Custom 27001779 Tray Catheter Urethral 14 BOTH IP/OP $16.00 $11.84 $0.00 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.88 $11.88 $12.33 $0.00 $3.33 $0.00 $0.00 $0.00 $0.00 $8.00 $12.67 $12.80 $0.00 $10.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001781 EAP Custom 27001781 Ace Wrap BOTH IP/OP $34.00 $25.16 $0.00 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $25.23 $25.23 $26.21 $0.00 $7.09 $0.00 $0.00 $0.00 $0.00 $17.00 $26.93 $27.20 $0.00 $22.10 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001782 EAP Custom 27001782 Splint BOTH IP/OP $64.00 $47.36 $0.00 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $47.50 $47.50 $49.33 $0.00 $13.34 $0.00 $0.00 $0.00 $0.00 $32.00 $50.69 $51.20 $0.00 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001783 EAP Custom 27001783 Splint - Supply BOTH IP/OP $266.00 $196.84 $0.00 $212.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $197.43 $197.43 $205.03 $0.00 $55.43 $0.00 $0.00 $0.00 $0.00 $133.00 $210.67 $212.80 $0.00 $172.90 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001785 EAP Custom 27001785 Ace Wrap BOTH IP/OP $34.00 $25.16 $0.00 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $25.23 $25.23 $26.21 $0.00 $7.09 $0.00 $0.00 $0.00 $0.00 $17.00 $26.93 $27.20 $0.00 $22.10 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001786 EAP Custom 27001786 Ace Wrap Supply BOTH IP/OP $31.00 $22.94 $0.00 $24.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $23.01 $23.01 $23.89 $0.00 $6.46 $0.00 $0.00 $0.00 $0.00 $15.50 $24.55 $24.80 $0.00 $20.15 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001788 EAP Custom 27001788 Wrist Brace BOTH IP/OP $60.00 $44.40 $0.00 $48.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $44.53 $44.53 $46.25 $0.00 $12.50 $0.00 $0.00 $0.00 $0.00 $30.00 $47.52 $48.00 $0.00 $39.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27001789 EAP Custom 27001789 Sling/fig. 8 BOTH IP/OP $83.00 $61.42 $0.00 $66.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $61.60 $61.60 $63.98 $0.00 $17.30 $0.00 $0.00 $0.00 $0.00 $41.50 $65.74 $66.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002257 EAP Custom 27002257 Cast Application Supply BOTH IP/OP $567.00 $419.58 $0.00 $453.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $420.83 $420.83 $437.04 $0.00 $118.16 $0.00 $0.00 $0.00 $0.00 $283.50 $449.06 $453.60 $0.00 $368.55 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002259 EAP Custom 27002259 Sling BOTH IP/OP $108.00 $79.92 $0.00 $86.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $80.16 $80.16 $83.25 $0.00 $22.51 $0.00 $0.00 $0.00 $0.00 $54.00 $85.54 $86.40 $0.00 $70.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002260 EAP Custom 27002260 Ace Bandage BOTH IP/OP $14.00 $10.36 $0.00 $11.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $10.39 $10.39 $10.79 $0.00 $2.92 $0.00 $0.00 $0.00 $0.00 $7.00 $11.09 $11.20 $0.00 $9.10 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002261 EAP Custom 27002261 Urinary Drainage Bag BOTH IP/OP $28.00 $20.72 $0.00 $22.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $20.78 $20.78 $21.58 $0.00 $5.84 $0.00 $0.00 $0.00 $0.00 $14.00 $22.18 $22.40 $0.00 $18.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002263 EAP Custom 27002263 Gastric Lavage Kit BOTH IP/OP $234.00 $173.16 $0.00 $187.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $173.67 $173.67 $180.37 $0.00 $48.77 $0.00 $0.00 $0.00 $0.00 $117.00 $185.33 $187.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002265 EAP Custom 27002265 Pelvic Tray BOTH IP/OP $138.00 $102.12 $0.00 $110.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $102.42 $102.42 $106.37 $0.00 $28.76 $0.00 $0.00 $0.00 $0.00 $69.00 $109.30 $110.40 $0.00 $89.70 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002266 EAP Custom 27002266 Peak Flow Meter BOTH IP/OP $343.00 $253.82 $0.00 $274.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $254.57 $254.57 $264.38 $0.00 $71.48 $0.00 $0.00 $0.00 $0.00 $171.50 $271.66 $274.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002267 EAP Custom 27002267 Ortho Traction Pins BOTH IP/OP $408.00 $301.92 $0.00 $326.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $302.82 $302.82 $314.49 $0.00 $85.03 $0.00 $0.00 $0.00 $0.00 $204.00 $323.14 $326.40 $0.00 $265.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002268 EAP Custom 27002268 Ace Bandage BOTH IP/OP $147.00 $108.78 $0.00 $117.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $109.10 $109.10 $113.31 $0.00 $30.63 $0.00 $0.00 $0.00 $0.00 $73.50 $116.42 $117.60 $0.00 $95.55 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002473 EAP Custom 27002473 Angiocath Iv Bb 18gx1.25in Nw BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $0.00 $0.00 $0.00 $9.50 $15.05 $15.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002510 EAP Custom 27002510 Nuva Ring BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $6.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002515 EAP Custom 27002515 Clavical Straps BOTH IP/OP $28.00 $20.72 $0.00 $22.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $20.78 $20.78 $21.58 $0.00 $5.84 $0.00 $0.00 $0.00 $0.00 $14.00 $22.18 $22.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002516 EAP Custom 27002516 Fiberglass Casting BOTH IP/OP $129.00 $95.46 $0.00 $103.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $95.74 $95.74 $99.43 $0.00 $26.88 $0.00 $0.00 $0.00 $0.00 $64.50 $102.17 $103.20 $0.00 $83.85 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002517 EAP Custom 27002517 Ankle Stirrup BOTH IP/OP $149.00 $110.26 $0.00 $119.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $110.59 $110.59 $114.85 $0.00 $31.05 $0.00 $0.00 $0.00 $0.00 $74.50 $118.01 $119.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002518 EAP Custom 27002518 Knee Immobilizer BOTH IP/OP $232.00 $171.68 $0.00 $185.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $172.19 $172.19 $178.83 $0.00 $48.35 $0.00 $0.00 $0.00 $0.00 $116.00 $183.74 $185.60 $0.00 $150.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002519 EAP Custom 27002519 Philadephia Collar BOTH IP/OP $193.00 $142.82 $0.00 $154.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $143.24 $143.24 $148.76 $0.00 $40.22 $0.00 $0.00 $0.00 $0.00 $96.50 $152.86 $154.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002520 EAP Custom 27002520 Cervical Collar BOTH IP/OP $43.00 $31.82 $0.00 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $31.91 $31.91 $33.14 $0.00 $8.96 $0.00 $0.00 $0.00 $0.00 $21.50 $34.06 $34.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002521 EAP Custom 27002521 Pavlik Harness BOTH IP/OP $178.00 $131.72 $0.00 $142.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $132.11 $132.11 $137.20 $0.00 $37.10 $0.00 $0.00 $0.00 $0.00 $89.00 $140.98 $142.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002522 EAP Custom 27002522 Cast Shoe BOTH IP/OP $51.00 $37.74 $0.00 $40.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $37.85 $37.85 $39.31 $0.00 $10.63 $0.00 $0.00 $0.00 $0.00 $25.50 $40.39 $40.80 $0.00 $33.15 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002523 EAP Custom 27002523 Shoulder Immobilizer BOTH IP/OP $232.00 $171.68 $0.00 $185.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $172.19 $172.19 $178.83 $0.00 $48.35 $0.00 $0.00 $0.00 $0.00 $116.00 $183.74 $185.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002524 EAP Custom 27002524 Post Op Shoe BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $24.70 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002525 EAP Custom 27002525 Hinged Knee Brace BOTH IP/OP $705.00 $521.70 $0.00 $564.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $523.25 $523.25 $543.41 $0.00 $146.92 $0.00 $0.00 $0.00 $0.00 $352.50 $558.36 $564.00 $0.00 $458.25 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002526 EAP Custom 27002526 Sling/fig. 8 BOTH IP/OP $88.00 $65.12 $0.00 $70.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $65.31 $65.31 $67.83 $0.00 $18.34 $0.00 $0.00 $0.00 $0.00 $44.00 $69.70 $70.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002527 EAP Custom 27002527 Hinged Knee Sleeve BOTH IP/OP $129.00 $95.46 $0.00 $103.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $95.74 $95.74 $99.43 $0.00 $26.88 $0.00 $0.00 $0.00 $0.00 $64.50 $102.17 $103.20 $0.00 $83.85 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002528 EAP Custom 27002528 Universal Knee Brace BOTH IP/OP $728.00 $538.72 $0.00 $582.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $540.32 $540.32 $561.14 $0.00 $151.72 $0.00 $0.00 $0.00 $0.00 $364.00 $576.58 $582.40 $0.00 $473.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002529 EAP Custom 27002529 Universal Knee Brace BOTH IP/OP $371.00 $274.54 $0.00 $296.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $275.36 $275.36 $285.97 $0.00 $77.32 $0.00 $0.00 $0.00 $0.00 $185.50 $293.83 $296.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002530 EAP Custom 27002530 3d Walking Boot BOTH IP/OP $197.00 $145.78 $0.00 $157.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $146.21 $146.21 $151.85 $0.00 $41.05 $0.00 $0.00 $0.00 $0.00 $98.50 $156.02 $157.60 $0.00 $128.05 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002531 EAP Custom 27002531 Knee Immobilizer BOTH IP/OP $232.00 $171.68 $0.00 $185.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $172.19 $172.19 $178.83 $0.00 $48.35 $0.00 $0.00 $0.00 $0.00 $116.00 $183.74 $185.60 $0.00 $150.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002532 EAP Custom 27002532 Shoulder Immobilizer BOTH IP/OP $232.00 $171.68 $0.00 $185.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $172.19 $172.19 $178.83 $0.00 $48.35 $0.00 $0.00 $0.00 $0.00 $116.00 $183.74 $185.60 $0.00 $150.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002533 EAP Custom 27002533 Philadelphia Collar BOTH IP/OP $207.00 $153.18 $0.00 $165.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $153.64 $153.64 $159.56 $0.00 $43.14 $0.00 $0.00 $0.00 $0.00 $103.50 $163.94 $165.60 $0.00 $134.55 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002534 EAP Custom 27002534 Soft Collar BOTH IP/OP $130.00 $96.20 $0.00 $104.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $96.49 $96.49 $100.20 $0.00 $27.09 $0.00 $0.00 $0.00 $0.00 $65.00 $102.96 $104.00 $0.00 $84.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002535 EAP Custom 27002535 Arm Sling BOTH IP/OP $94.00 $69.56 $0.00 $75.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $69.77 $69.77 $72.46 $0.00 $19.59 $0.00 $0.00 $0.00 $0.00 $47.00 $74.45 $75.20 $0.00 $61.10 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002536 EAP Custom 27002536 Active Ankle Brace BOTH IP/OP $417.00 $308.58 $0.00 $333.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $309.50 $309.50 $321.42 $0.00 $86.90 $0.00 $0.00 $0.00 $0.00 $208.50 $330.26 $333.60 $0.00 $271.05 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002537 EAP Custom 27002537 Buck's Traction Splint BOTH IP/OP $172.00 $127.28 $0.00 $137.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $127.66 $127.66 $132.58 $0.00 $35.84 $0.00 $0.00 $0.00 $0.00 $86.00 $136.22 $137.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002538 EAP Custom 27002538 Knee Brace BOTH IP/OP $762.00 $563.88 $0.00 $609.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $565.56 $565.56 $587.35 $0.00 $158.80 $0.00 $0.00 $0.00 $0.00 $381.00 $603.50 $609.60 $0.00 $495.30 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002539 EAP Custom 27002539 Jacksonville Sling BOTH IP/OP $88.00 $65.12 $0.00 $70.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $65.31 $65.31 $67.83 $0.00 $18.34 $0.00 $0.00 $0.00 $0.00 $44.00 $69.70 $70.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002541 EAP Custom 27002541 Cast Over Wrap BOTH IP/OP $94.00 $69.56 $0.00 $75.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $47.00 $74.45 $75.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002542 EAP Custom 27002542 Cast Over Wrap-fiberglass BOTH IP/OP $117.00 $86.58 $0.00 $93.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $58.50 $92.66 $93.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002543 EAP Custom 27002543 Sandbag BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $0.00 $0.00 $0.00 $9.50 $15.05 $15.20 $0.00 $12.35 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002544 EAP Custom 27002544 Aspen Collar BOTH IP/OP $154.00 $113.96 $0.00 $123.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $114.30 $114.30 $118.70 $0.00 $32.09 $0.00 $0.00 $0.00 $0.00 $77.00 $121.97 $123.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002545 EAP Custom 27002545 Miami J. Collar BOTH IP/OP $195.00 $144.30 $0.00 $156.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $144.73 $144.73 $150.31 $0.00 $40.64 $0.00 $0.00 $0.00 $0.00 $97.50 $154.44 $156.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002546 EAP Custom 27002546 Atlas Collar BOTH IP/OP $194.00 $143.56 $0.00 $155.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $143.99 $143.99 $149.54 $0.00 $40.43 $0.00 $0.00 $0.00 $0.00 $97.00 $153.65 $155.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002547 EAP Custom 27002547 Pediatric Pmt Collar BOTH IP/OP $63.00 $46.62 $0.00 $50.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $46.76 $46.76 $48.56 $0.00 $13.13 $0.00 $0.00 $0.00 $0.00 $31.50 $49.90 $50.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002548 EAP Custom 27002548 Abduction Pillow BOTH IP/OP $96.00 $71.04 $0.00 $76.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $71.25 $71.25 $74.00 $0.00 $20.01 $0.00 $0.00 $0.00 $0.00 $48.00 $76.03 $76.80 $0.00 $62.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002549 EAP Custom 27002549 Neoprene Knee Sleeve BOTH IP/OP $68.00 $50.32 $0.00 $54.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $50.47 $50.47 $52.41 $0.00 $14.17 $0.00 $0.00 $0.00 $0.00 $34.00 $53.86 $54.40 $0.00 $44.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002550 EAP Custom 27002550 Cuff And Collar BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $24.70 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002551 EAP Custom 27002551 Post Op Shoe BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $24.70 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002552 EAP Custom 27002552 Tlso Pre Fab BOTH IP/OP "$2,419.00 " "$1,790.06" $0.00 "$1,935.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,795.38" "$1,795.38" "$1,864.57" $0.00 $504.12 $0.00 $0.00 $0.00 $0.00 "$1,209.50" "$1,915.85" "$1,935.20" $0.00 "$1,572.35" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002564 EAP CPT® C1751 "Cvp Kit, Double Lumen" BOTH IP/OP $569.00 $421.06 $0.00 $455.20 $308.97 $308.97 $0.00 $0.00 $0.00 $118.59 $422.31 $422.31 $438.59 $0.00 $118.58 $0.00 $336.56 $336.56 $0.00 $284.50 $450.65 $455.20 $0.00 $369.85 $0.00 $89.05 $0.00 $0.00 $90.58 $0.00 $0.00 $0.00 $0.00 $0.00 27002565 EAP Custom 27002565 "Ett, Double-lumen" BOTH IP/OP $837.00 $619.38 $0.00 $669.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $621.22 $621.22 $645.16 $0.00 $174.43 $0.00 $0.00 $0.00 $0.00 $418.50 $662.90 $669.60 $0.00 $544.05 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002572 EAP Custom 27002572 Introducer Kit BOTH IP/OP $261.00 $193.14 $0.00 $208.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $193.71 $193.71 $201.18 $0.00 $54.39 $0.00 $0.00 $0.00 $0.00 $130.50 $206.71 $208.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002573 EAP Custom 27002573 Radial Artery Set (arrow) BOTH IP/OP $92.00 $68.08 $0.00 $73.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $68.28 $68.28 $70.91 $0.00 $19.17 $0.00 $0.00 $0.00 $0.00 $46.00 $72.86 $73.60 $0.00 $59.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002576 EAP Custom 27002576 Epidural Tray BOTH IP/OP $316.00 $233.84 $0.00 $252.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $234.54 $234.54 $243.57 $0.00 $65.85 $0.00 $0.00 $0.00 $0.00 $158.00 $250.27 $252.80 $0.00 $205.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002579 EAP Custom 27002579 Level One Inserts BOTH IP/OP $101.00 $74.74 $0.00 $80.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $74.96 $74.96 $77.85 $0.00 $21.05 $0.00 $0.00 $0.00 $0.00 $50.50 $79.99 $80.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002587 EAP HCPCS C1751 Kit Quad Lumen Cather BOTH IP/OP $148.00 $109.52 $0.00 $118.40 $80.36 $80.36 $0.00 $0.00 $0.00 $30.85 $109.85 $109.85 $114.08 $0.00 $30.84 $0.00 $87.54 $87.54 $0.00 $74.00 $117.22 $118.40 $0.00 $96.20 $0.00 $23.16 $0.00 $0.00 $23.56 $0.00 $0.00 $0.00 $0.00 $0.00 27002589 EAP Custom 27002589 Aintree Intubation Changer BOTH IP/OP $83.00 $61.42 $0.00 $66.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $61.60 $61.60 $63.98 $0.00 $17.30 $0.00 $0.00 $0.00 $0.00 $41.50 $65.74 $66.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002590 EAP Custom 27002590 Kit Triple Lumen Catheter BOTH IP/OP $646.00 $478.04 $0.00 $516.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $479.46 $479.46 $497.94 $0.00 $134.63 $0.00 $0.00 $0.00 $0.00 $323.00 $511.63 $516.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002593 EAP Custom 27002593 "Cvp Kit, Double Lumen" BOTH IP/OP $307.00 $227.18 $0.00 $245.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $227.86 $227.86 $236.64 $0.00 $63.98 $0.00 $0.00 $0.00 $0.00 $153.50 $243.14 $245.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002594 EAP Custom 27002594 "Transducer And Tubing, Disp" BOTH IP/OP $60.00 $44.40 $0.00 $48.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $44.53 $44.53 $46.25 $0.00 $12.50 $0.00 $0.00 $0.00 $0.00 $30.00 $47.52 $48.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002595 EAP Custom 27002595 Fiberoptic Intubation Scope BOTH IP/OP $321.00 $237.54 $0.00 $256.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $238.25 $238.25 $247.43 $0.00 $66.90 $0.00 $0.00 $0.00 $0.00 $160.50 $254.23 $256.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002598 EAP Custom 27002598 Air Embolism Detector BOTH IP/OP $69.00 $51.06 $0.00 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $51.21 $51.21 $53.19 $0.00 $14.38 $0.00 $0.00 $0.00 $0.00 $34.50 $54.65 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002599 EAP Custom 27002599 Introducer Kit BOTH IP/OP $64.00 $47.36 $0.00 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $47.50 $47.50 $49.33 $0.00 $13.34 $0.00 $0.00 $0.00 $0.00 $32.00 $50.69 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002600 EAP Custom 27002600 Radial Artery Set (arrow) BOTH IP/OP $20.00 $14.80 $0.00 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.84 $14.84 $15.42 $0.00 $4.17 $0.00 $0.00 $0.00 $0.00 $10.00 $15.84 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002602 EAP Custom 27002602 Disp. Sao2 Probe BOTH IP/OP $61.00 $45.14 $0.00 $48.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $45.27 $45.27 $47.02 $0.00 $12.71 $0.00 $0.00 $0.00 $0.00 $30.50 $48.31 $48.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002604 EAP Custom 27002604 Epidural Tray BOTH IP/OP $132.00 $97.68 $0.00 $105.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $97.97 $97.97 $101.75 $0.00 $27.51 $0.00 $0.00 $0.00 $0.00 $66.00 $104.54 $105.60 $0.00 $85.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002605 EAP Custom 27002605 Spinal Tray BOTH IP/OP $190.00 $140.60 $0.00 $152.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $141.02 $141.02 $146.45 $0.00 $39.60 $0.00 $0.00 $0.00 $0.00 $95.00 $150.48 $152.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002609 EAP Custom 27002609 Thoracotomy Tray BOTH IP/OP $132.00 $97.68 $0.00 $105.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $97.97 $97.97 $101.75 $0.00 $27.51 $0.00 $0.00 $0.00 $0.00 $66.00 $104.54 $105.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002610 EAP Custom 27002610 Tracheotomy Tray BOTH IP/OP $394.00 $291.56 $0.00 $315.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $292.43 $292.43 $303.70 $0.00 $82.11 $0.00 $0.00 $0.00 $0.00 $197.00 $312.05 $315.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002618 EAP Custom 27002618 Ioban 2 Drape Incise Smal BOTH IP/OP $40.00 $29.60 $0.00 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $29.69 $29.69 $30.83 $0.00 $8.34 $0.00 $0.00 $0.00 $0.00 $20.00 $31.68 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002620 EAP Custom 27002620 Ioban 2 Drape Incise Larg BOTH IP/OP $434.00 $321.16 $0.00 $347.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $322.11 $322.11 $334.53 $0.00 $90.45 $0.00 $0.00 $0.00 $0.00 $217.00 $343.73 $347.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002621 EAP Custom 27002621 Needle Spinal 18ga BOTH IP/OP $15.00 $11.10 $0.00 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.13 $11.13 $11.56 $0.00 $3.13 $0.00 $0.00 $0.00 $0.00 $7.50 $11.88 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002624 EAP Custom 27002624 Catheter Texas Large BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002625 EAP Custom 27002625 Catheter Thoracic 32fr BOTH IP/OP $40.00 $29.60 $0.00 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $29.69 $29.69 $30.83 $0.00 $8.34 $0.00 $0.00 $0.00 $0.00 $20.00 $31.68 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002626 EAP Custom 27002626 Catheter Thoracic 36fr BOTH IP/OP $40.00 $29.60 $0.00 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $29.69 $29.69 $30.83 $0.00 $8.34 $0.00 $0.00 $0.00 $0.00 $20.00 $31.68 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002627 EAP Custom 27002627 Catheter Urethral Two-eye BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002628 EAP Custom 27002628 Artery Arterial Catheriza BOTH IP/OP $102.00 $75.48 $0.00 $81.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $75.70 $75.70 $78.62 $0.00 $21.26 $0.00 $0.00 $0.00 $0.00 $51.00 $80.78 $81.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002629 EAP Custom 27002629 Artery Radial Catherizati BOTH IP/OP $65.00 $48.10 $0.00 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $48.24 $48.24 $50.10 $0.00 $13.55 $0.00 $0.00 $0.00 $0.00 $32.50 $51.48 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002630 EAP Custom 27002630 Tube Salem Sump 48 Lengt BOTH IP/OP $36.00 $26.64 $0.00 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $26.72 $26.72 $27.75 $0.00 $7.50 $0.00 $0.00 $0.00 $0.00 $18.00 $28.51 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002631 EAP Custom 27002631 Tube Salem Silicone Size BOTH IP/OP $36.00 $26.64 $0.00 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $26.72 $26.72 $27.75 $0.00 $7.50 $0.00 $0.00 $0.00 $0.00 $18.00 $28.51 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002632 EAP Custom 27002632 Tubes Salem Sump 48 Leng BOTH IP/OP $36.00 $26.64 $0.00 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $26.72 $26.72 $27.75 $0.00 $7.50 $0.00 $0.00 $0.00 $0.00 $18.00 $28.51 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002636 EAP Custom 27002636 Bag Drainage Becker BOTH IP/OP $197.00 $145.78 $0.00 $157.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $146.21 $146.21 $151.85 $0.00 $41.05 $0.00 $0.00 $0.00 $0.00 $98.50 $156.02 $157.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002637 EAP Custom 27002637 Scapel Surg W/handle Atta BOTH IP/OP $142.00 $105.08 $0.00 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $105.39 $105.39 $109.45 $0.00 $29.59 $0.00 $0.00 $0.00 $0.00 $71.00 $112.46 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002640 EAP Custom 27002640 Set Blood Administration BOTH IP/OP $34.00 $25.16 $0.00 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $25.23 $25.23 $26.21 $0.00 $7.09 $0.00 $0.00 $0.00 $0.00 $17.00 $26.93 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002643 EAP Custom 27002643 Cream Baza 5oz BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002646 EAP Custom 27002646 Electrodes Operative BOTH IP/OP $266.00 $196.84 $0.00 $212.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $197.43 $197.43 $205.03 $0.00 $55.43 $0.00 $0.00 $0.00 $0.00 $133.00 $210.67 $212.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002647 EAP Custom 27002647 Valve Anti-reflux Salem S BOTH IP/OP $46.00 $34.04 $0.00 $36.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $34.14 $34.14 $35.46 $0.00 $9.59 $0.00 $0.00 $0.00 $0.00 $23.00 $36.43 $36.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002649 EAP Custom 27002649 Kit Thoracotomy BOTH IP/OP $203.00 $150.22 $0.00 $162.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $150.67 $150.67 $156.47 $0.00 $42.31 $0.00 $0.00 $0.00 $0.00 $101.50 $160.78 $162.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002653 EAP Custom 27002653 Set Pediatric Measured Fi BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002656 EAP Custom 27002656 Pouch Fecal Incontinence BOTH IP/OP $50.00 $37.00 $0.00 $40.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $37.11 $37.11 $38.54 $0.00 $10.42 $0.00 $0.00 $0.00 $0.00 $25.00 $39.60 $40.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002657 EAP Custom 27002657 Kit Pressure Monitoring T BOTH IP/OP $163.00 $120.62 $0.00 $130.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $120.98 $120.98 $125.64 $0.00 $33.97 $0.00 $0.00 $0.00 $0.00 $81.50 $129.10 $130.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002658 EAP Custom 27002658 Transducer Disp For Icp BOTH IP/OP $70.00 $51.80 $0.00 $56.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $51.95 $51.95 $53.96 $0.00 $14.59 $0.00 $0.00 $0.00 $0.00 $35.00 $55.44 $56.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002659 EAP Custom 27002659 Kit Transducer Monitoring BOTH IP/OP $313.00 $231.62 $0.00 $250.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $232.31 $232.31 $241.26 $0.00 $65.23 $0.00 $0.00 $0.00 $0.00 $156.50 $247.90 $250.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002660 EAP Custom 27002660 Kit Pressure Monitoring BOTH IP/OP $234.00 $173.16 $0.00 $187.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $173.67 $173.67 $180.37 $0.00 $48.77 $0.00 $0.00 $0.00 $0.00 $117.00 $185.33 $187.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002662 EAP Custom 27002662 Bag 1000ml Pump Set BOTH IP/OP $37.00 $27.38 $0.00 $29.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $27.46 $27.46 $28.52 $0.00 $7.71 $0.00 $0.00 $0.00 $0.00 $18.50 $29.30 $29.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002663 EAP Custom 27002663 Kit Pecutaneous Introduce BOTH IP/OP $276.00 $204.24 $0.00 $220.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $204.85 $204.85 $212.74 $0.00 $57.52 $0.00 $0.00 $0.00 $0.00 $138.00 $218.59 $220.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002664 EAP Custom 27002664 Chest Unit Drainage Pleur BOTH IP/OP $420.00 $310.80 $0.00 $336.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $311.72 $311.72 $323.74 $0.00 $87.53 $0.00 $0.00 $0.00 $0.00 $210.00 $332.64 $336.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002665 EAP Custom 27002665 Chest Unit Dry Suction Sy BOTH IP/OP $309.00 $228.66 $0.00 $247.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $229.34 $229.34 $238.18 $0.00 $64.40 $0.00 $0.00 $0.00 $0.00 $154.50 $244.73 $247.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002666 EAP Custom 27002666 Bag Auto-transfusion Ple BOTH IP/OP $245.00 $181.30 $0.00 $196.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $181.84 $181.84 $188.85 $0.00 $51.06 $0.00 $0.00 $0.00 $0.00 $122.50 $194.04 $196.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002670 EAP Custom 27002670 Tube Feeding Ng 8fr 36in Entr BOTH IP/OP $61.00 $45.14 $0.00 $48.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $45.27 $45.27 $47.02 $0.00 $12.71 $0.00 $0.00 $0.00 $0.00 $30.50 $48.31 $48.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002671 EAP Custom 27002671 Kit Triple Lumen Catheter BOTH IP/OP $646.00 $478.04 $0.00 $516.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $479.46 $479.46 $497.94 $0.00 $134.63 $0.00 $0.00 $0.00 $0.00 $323.00 $511.63 $516.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002672 EAP Custom 27002672 Catheter Swan Ganz BOTH IP/OP $674.00 $498.76 $0.00 $539.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $500.24 $500.24 $519.52 $0.00 $140.46 $0.00 $0.00 $0.00 $0.00 $337.00 $533.81 $539.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002673 EAP Custom 27002673 Delivery System Closed In BOTH IP/OP $141.00 $104.34 $0.00 $112.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $104.65 $104.65 $108.68 $0.00 $29.38 $0.00 $0.00 $0.00 $0.00 $70.50 $111.67 $112.80 $0.00 $91.65 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002676 EAP Custom 27002676 Filter Set 0.22 Micron BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $0.00 $0.00 $0.00 $9.50 $15.05 $15.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002677 EAP Custom 27002677 Tray Catheter Urethral 14 BOTH IP/OP $16.00 $11.84 $0.00 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.88 $11.88 $12.33 $0.00 $3.33 $0.00 $0.00 $0.00 $0.00 $8.00 $12.67 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002678 EAP Custom 27002678 Tray Foley Preconnected W BOTH IP/OP $42.00 $31.08 $0.00 $33.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $31.17 $31.17 $32.37 $0.00 $8.75 $0.00 $0.00 $0.00 $0.00 $21.00 $33.26 $33.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002679 EAP Custom 27002679 Tray Foley Perconnected 1 BOTH IP/OP $52.00 $38.48 $0.00 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $38.59 $38.59 $40.08 $0.00 $10.84 $0.00 $0.00 $0.00 $0.00 $26.00 $41.18 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002681 EAP Custom 27002681 Tray Urine Meter 18fr BOTH IP/OP $85.00 $62.90 $0.00 $68.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $63.09 $63.09 $65.52 $0.00 $17.71 $0.00 $0.00 $0.00 $0.00 $42.50 $67.32 $68.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002682 EAP Custom 27002682 Tray Thoracentesis Dispos BOTH IP/OP $216.00 $159.84 $0.00 $172.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $160.32 $160.32 $166.49 $0.00 $45.01 $0.00 $0.00 $0.00 $0.00 $108.00 $171.07 $172.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002684 EAP Custom 27002684 Bag Drainage Ureteral BOTH IP/OP $92.00 $68.08 $0.00 $73.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $68.28 $68.28 $70.91 $0.00 $19.17 $0.00 $0.00 $0.00 $0.00 $46.00 $72.86 $73.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002687 EAP Custom 27002687 Sleeve Knee Regular Dvt BOTH IP/OP $358.00 $264.92 $0.00 $286.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $265.71 $265.71 $275.95 $0.00 $74.61 $0.00 $0.00 $0.00 $0.00 $179.00 $283.54 $286.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002688 EAP Custom 27002688 Sleeve Knee X-large Dvt BOTH IP/OP $439.00 $324.86 $0.00 $351.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $325.83 $325.83 $338.38 $0.00 $91.49 $0.00 $0.00 $0.00 $0.00 $219.50 $347.69 $351.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002689 EAP Custom 27002689 Sleeve Thigh Regular Dvt BOTH IP/OP $512.00 $378.88 $0.00 $409.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $380.01 $380.01 $394.65 $0.00 $106.70 $0.00 $0.00 $0.00 $0.00 $256.00 $405.50 $409.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002697 EAP Custom 27002697 Catheter Suction Plastic 14 BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002701 EAP Custom 27002701 Set Pediatric Micro Drip BOTH IP/OP $28.00 $20.72 $0.00 $22.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $20.78 $20.78 $21.58 $0.00 $5.84 $0.00 $0.00 $0.00 $0.00 $14.00 $22.18 $22.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002702 EAP Custom 27002702 Set Pediatric Measured Fi BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002703 EAP Custom 27002703 Stockings Antiembolism Thigh BOTH IP/OP $22.00 $16.28 $0.00 $17.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $16.33 $16.33 $16.96 $0.00 $4.58 $0.00 $0.00 $0.00 $0.00 $11.00 $17.42 $17.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002704 EAP Custom 27002704 Stockings Antiembolism Thigh BOTH IP/OP $44.00 $32.56 $0.00 $35.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $32.66 $32.66 $33.92 $0.00 $9.17 $0.00 $0.00 $0.00 $0.00 $22.00 $34.85 $35.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002705 EAP Custom 27002705 Stockings Antiembolism Thigh BOTH IP/OP $50.00 $37.00 $0.00 $40.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $37.11 $37.11 $38.54 $0.00 $10.42 $0.00 $0.00 $0.00 $0.00 $25.00 $39.60 $40.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002706 EAP Custom 27002706 Stockings Antiembolish Ex BOTH IP/OP $36.00 $26.64 $0.00 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $26.72 $26.72 $27.75 $0.00 $7.50 $0.00 $0.00 $0.00 $0.00 $18.00 $28.51 $28.80 $0.00 $23.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002707 EAP Custom 27002707 Needle Port-cath 20ga X 1 BOTH IP/OP $34.00 $25.16 $0.00 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $25.23 $25.23 $26.21 $0.00 $7.09 $0.00 $0.00 $0.00 $0.00 $17.00 $26.93 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002708 EAP Custom 27002708 Tray Catheter Urethral 14 BOTH IP/OP $16.00 $11.84 $0.00 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.88 $11.88 $12.33 $0.00 $3.33 $0.00 $0.00 $0.00 $0.00 $8.00 $12.67 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002709 EAP Custom 27002709 Tray Foley Preconnected 1 BOTH IP/OP $52.00 $38.48 $0.00 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $38.59 $38.59 $40.08 $0.00 $10.84 $0.00 $0.00 $0.00 $0.00 $26.00 $41.18 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002710 EAP Custom 27002710 Bag Urine Leg BOTH IP/OP $15.00 $11.10 $0.00 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.13 $11.13 $11.56 $0.00 $3.13 $0.00 $0.00 $0.00 $0.00 $7.50 $11.88 $12.00 $0.00 $9.75 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002884 EAP Custom 27002884 Et/co2 Sensors BOTH IP/OP $34.00 $25.16 $0.00 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $25.23 $25.23 $26.21 $0.00 $7.09 $0.00 $0.00 $0.00 $0.00 $17.00 $26.93 $27.20 $0.00 $22.10 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002885 EAP Custom 27002885 Cpap Circuit BOTH IP/OP "$1,347.00 " $996.78 $0.00 "$1,077.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $999.74 $999.74 "$1,038.27" $0.00 $280.71 $0.00 $0.00 $0.00 $0.00 $673.50 "$1,066.82" "$1,077.60" $0.00 $875.55 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002886 EAP Custom 27002886 Flutter Valve BOTH IP/OP $167.00 $123.58 $0.00 $133.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $123.95 $123.95 $128.72 $0.00 $34.80 $0.00 $0.00 $0.00 $0.00 $83.50 $132.26 $133.60 $0.00 $108.55 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002892 EAP Custom 27002892 Fecal Occult Blood Supply BOTH IP/OP $40.00 $29.60 $0.00 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $29.69 $29.69 $30.83 $0.00 $8.34 $0.00 $0.00 $0.00 $0.00 $20.00 $31.68 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002893 EAP Custom 27002893 Tubes Extension Plain Pla BOTH IP/OP $15.00 $11.10 $0.00 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.13 $11.13 $11.56 $0.00 $3.13 $0.00 $0.00 $0.00 $0.00 $7.50 $11.88 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002908 EAP Custom 27002908 Kit Iv Start Custom BOTH IP/OP $20.00 $14.80 $0.00 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $10.00 $15.84 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002938 EAP Custom 27002938 Inflation Device BOTH IP/OP $250.00 $185.00 $0.00 $200.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $185.55 $185.55 $192.70 $0.00 $52.10 $0.00 $0.00 $0.00 $0.00 $125.00 $198.00 $200.00 $0.00 $162.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002939 EAP Custom 27002939 "Catheter, Thrombectomy" BOTH IP/OP "$1,076.00 " $796.24 $0.00 $860.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $798.61 $798.61 $829.38 $0.00 $224.24 $0.00 $0.00 $0.00 $0.00 $538.00 $852.19 $860.80 $0.00 $699.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002940 EAP HCPCS C1751 Catheter Iv 180ga X 1x1/4 BOTH IP/OP $16.00 $11.84 $0.00 $12.80 $8.69 $8.69 $0.00 $0.00 $0.00 $3.33 $11.88 $11.88 $12.33 $0.00 $3.33 $0.00 $9.46 $9.46 $0.00 $8.00 $12.67 $12.80 $0.00 $0.00 $0.00 $2.50 $0.00 $0.00 $2.55 $0.00 $0.00 $0.00 $0.00 $0.00 27002941 EAP HCPCS C1751 Catheter Iv 20ga X 1 BOTH IP/OP $16.00 $11.84 $0.00 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $8.00 $12.67 $12.80 $0.00 $0.00 $0.00 $2.50 $0.00 $0.00 $2.55 $0.00 $0.00 $0.00 $0.00 $0.00 27002942 EAP HCPCS C1751 Catheter Iv 22ga X 1 BOTH IP/OP $16.00 $11.84 $0.00 $12.80 $8.69 $8.69 $0.00 $0.00 $0.00 $3.33 $11.88 $11.88 $12.33 $0.00 $3.33 $0.00 $9.46 $9.46 $0.00 $8.00 $12.67 $12.80 $0.00 $0.00 $0.00 $2.50 $0.00 $0.00 $2.55 $0.00 $0.00 $0.00 $0.00 $0.00 27002943 EAP Custom 27002943 Ioban 2 Drape Incise Medi BOTH IP/OP $56.00 $41.44 $0.00 $44.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $41.56 $41.56 $43.16 $0.00 $11.67 $0.00 $0.00 $0.00 $0.00 $28.00 $44.35 $44.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002944 EAP Custom 27002944 Needle Spinal 18ga BOTH IP/OP $15.00 $11.10 $0.00 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.13 $11.13 $11.56 $0.00 $3.13 $0.00 $0.00 $0.00 $0.00 $7.50 $11.88 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002945 EAP Custom 27002945 Lancet Grady Orange BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002946 EAP HCPCS C1751 Catheter Iv Cut-down 14g BOTH IP/OP $44.00 $32.56 $0.00 $35.20 $23.89 $23.89 $0.00 $0.00 $0.00 $9.17 $32.66 $32.66 $33.92 $0.00 $9.17 $0.00 $26.03 $26.03 $0.00 $22.00 $34.85 $35.20 $0.00 $0.00 $0.00 $6.89 $0.00 $0.00 $7.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002947 EAP HCPCS C1751 Catheter Iv Cut-down 8 1 BOTH IP/OP $44.00 $32.56 $0.00 $35.20 $23.89 $23.89 $0.00 $0.00 $0.00 $9.17 $32.66 $32.66 $33.92 $0.00 $9.17 $0.00 $26.03 $26.03 $0.00 $22.00 $34.85 $35.20 $0.00 $0.00 $0.00 $6.89 $0.00 $0.00 $7.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002951 EAP HCPCS C1729 Catheter Foley 5cc 14fr BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $10.32 $10.32 $0.00 $0.00 $0.00 $3.96 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $11.24 $11.24 $0.00 $9.50 $15.05 $15.20 $0.00 $0.00 $0.00 $2.97 $0.00 $0.00 $3.02 $0.00 $0.00 $0.00 $0.00 $0.00 27002952 EAP HCPCS C1729 Catheter Foley 16fr BOTH IP/OP $18.00 $13.32 $0.00 $14.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.00 $14.26 $14.40 $0.00 $0.00 $0.00 $2.82 $0.00 $0.00 $2.87 $0.00 $0.00 $0.00 $0.00 $0.00 27002953 EAP HCPCS C1729 Catheter Foley 5cc 18fr BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $10.32 $10.32 $0.00 $0.00 $0.00 $3.96 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $11.24 $11.24 $0.00 $9.50 $15.05 $15.20 $0.00 $0.00 $0.00 $2.97 $0.00 $0.00 $3.02 $0.00 $0.00 $0.00 $0.00 $0.00 27002954 EAP Custom 27002954 Tube Salem Silicone Size BOTH IP/OP $36.00 $26.64 $0.00 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $26.72 $26.72 $27.75 $0.00 $7.50 $0.00 $0.00 $0.00 $0.00 $18.00 $28.51 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002955 EAP Custom 27002955 Tubes Salem Sump 48 Leng BOTH IP/OP $36.00 $26.64 $0.00 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $26.72 $26.72 $27.75 $0.00 $7.50 $0.00 $0.00 $0.00 $0.00 $18.00 $28.51 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002957 EAP Custom 27002957 Scaple Surg W/handle Atta BOTH IP/OP $152.00 $112.48 $0.00 $121.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $112.81 $112.81 $117.16 $0.00 $31.68 $0.00 $0.00 $0.00 $0.00 $76.00 $120.38 $121.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002958 EAP Custom 27002958 Scaple Surg W/handle Attached BOTH IP/OP $15.00 $11.10 $0.00 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.13 $11.13 $11.56 $0.00 $3.13 $0.00 $0.00 $0.00 $0.00 $7.50 $11.88 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002959 EAP Custom 27002959 Bore Y Extension Small BOTH IP/OP $26.00 $19.24 $0.00 $20.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $19.30 $19.30 $20.04 $0.00 $5.42 $0.00 $0.00 $0.00 $0.00 $13.00 $20.59 $20.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002961 EAP Custom 27002961 Pad Defi BOTH IP/OP $50.00 $37.00 $0.00 $40.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $37.11 $37.11 $38.54 $0.00 $10.42 $0.00 $0.00 $0.00 $0.00 $25.00 $39.60 $40.00 $0.00 $32.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002962 EAP Custom 27002962 Valve Reflux BOTH IP/OP $3.00 $2.22 $0.00 $2.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $2.23 $2.23 $2.31 $0.00 $0.63 $0.00 $0.00 $0.00 $0.00 $1.50 $2.38 $2.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002963 EAP Custom 27002963 "Filter,micron .22 Fluid A" BOTH IP/OP $14.00 $10.36 $0.00 $11.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $10.39 $10.39 $10.79 $0.00 $2.92 $0.00 $0.00 $0.00 $0.00 $7.00 $11.09 $11.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002964 EAP Custom 27002964 Set Scalp Vein Infusion 21 G BOTH IP/OP $3.00 $2.22 $0.00 $2.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $2.23 $2.23 $2.31 $0.00 $0.63 $0.00 $0.00 $0.00 $0.00 $1.50 $2.38 $2.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002965 EAP Custom 27002965 Mask Sub-micron Small BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002966 EAP Custom 27002966 Kit Triple Lumen Catheter BOTH IP/OP $646.00 $478.04 $0.00 $516.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $479.46 $479.46 $497.94 $0.00 $134.63 $0.00 $0.00 $0.00 $0.00 $323.00 $511.63 $516.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002967 EAP Custom 27002967 Catheter Swan Ganz BOTH IP/OP $674.00 $498.76 $0.00 $539.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $500.24 $500.24 $519.52 $0.00 $140.46 $0.00 $0.00 $0.00 $0.00 $337.00 $533.81 $539.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002968 EAP Custom 27002968 Probe V-pacing BOTH IP/OP "$1,403.00 " "$1,038.22" $0.00 "$1,122.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,041.31" "$1,041.31" "$1,081.43" $0.00 $292.39 $0.00 $0.00 $0.00 $0.00 $701.50 "$1,111.18" "$1,122.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002969 EAP Custom 27002969 Filter Set 0.22 Micron BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002970 EAP Custom 27002970 Tray Foley Preconnected 1 BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002971 EAP Custom 27002971 Tray Foley Perconnected 1 BOTH IP/OP $14.00 $10.36 $0.00 $11.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $10.39 $10.39 $10.79 $0.00 $2.92 $0.00 $0.00 $0.00 $0.00 $7.00 $11.09 $11.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002972 EAP Custom 27002972 Bag Urine Leg BOTH IP/OP $15.00 $11.10 $0.00 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.13 $11.13 $11.56 $0.00 $3.13 $0.00 $0.00 $0.00 $0.00 $7.50 $11.88 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002973 EAP Custom 27002973 Pounches Sterilization 12 BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002974 EAP Custom 27002974 Bag Drainage Ureteral BOTH IP/OP $103.00 $76.22 $0.00 $82.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $76.45 $76.45 $79.39 $0.00 $21.47 $0.00 $0.00 $0.00 $0.00 $51.50 $81.58 $82.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002975 EAP Custom 27002975 Needle Hypodermic Sterile BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002976 EAP Custom 27002976 Drape Half BOTH IP/OP $6.00 $4.44 $0.00 $4.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $4.45 $4.45 $4.62 $0.00 $1.25 $0.00 $0.00 $0.00 $0.00 $3.00 $4.75 $4.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002978 EAP Custom 27002978 Jcd 5.0-38-20 BOTH IP/OP $17.00 $12.58 $0.00 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $12.62 $12.62 $13.10 $0.00 $3.54 $0.00 $0.00 $0.00 $0.00 $8.50 $13.46 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002979 EAP Custom 27002979 Jcd 7.0-38-20 BOTH IP/OP $17.00 $12.58 $0.00 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $12.62 $12.62 $13.10 $0.00 $3.54 $0.00 $0.00 $0.00 $0.00 $8.50 $13.46 $13.60 $0.00 $11.05 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002980 EAP Custom 27002980 Jcd 8.0-38-20 BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002982 EAP Custom 27002982 Avantiplus Introducer 6fr 23cm BOTH IP/OP $80.00 $59.20 $0.00 $64.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $59.38 $59.38 $61.66 $0.00 $16.67 $0.00 $0.00 $0.00 $0.00 $40.00 $63.36 $64.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002984 EAP Custom 27002984 Nail Cleaner Plastic Non-steri BOTH IP/OP $65.00 $48.10 $0.00 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $48.24 $48.24 $50.10 $0.00 $13.55 $0.00 $0.00 $0.00 $0.00 $32.50 $51.48 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002985 EAP Custom 27002985 Super Arrow Flex Introducer-c BOTH IP/OP $425.00 $314.50 $0.00 $340.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $315.44 $315.44 $327.59 $0.00 $88.57 $0.00 $0.00 $0.00 $0.00 $212.50 $336.60 $340.00 $0.00 $276.25 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002986 EAP Custom 27002986 6fr-24cm Flexsheath Introducer BOTH IP/OP $185.00 $136.90 $0.00 $148.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $137.31 $137.31 $142.60 $0.00 $38.55 $0.00 $0.00 $0.00 $0.00 $92.50 $146.52 $148.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002987 EAP Custom 27002987 8fr-35cm Flexsheath Introducer BOTH IP/OP $185.00 $136.90 $0.00 $148.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $137.31 $137.31 $142.60 $0.00 $38.55 $0.00 $0.00 $0.00 $0.00 $92.50 $146.52 $148.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002990 EAP Custom 27002990 Adapter Morse - Y BOTH IP/OP $80.00 $59.20 $0.00 $64.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $59.38 $59.38 $61.66 $0.00 $16.67 $0.00 $0.00 $0.00 $0.00 $40.00 $63.36 $64.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002991 EAP Custom 27002991 Drape C-arm 42 X 64 BOTH IP/OP $20.00 $14.80 $0.00 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.84 $14.84 $15.42 $0.00 $4.17 $0.00 $0.00 $0.00 $0.00 $10.00 $15.84 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002993 EAP Custom 27002993 Kit Catheter Suction 14fr BOTH IP/OP $810.00 $599.40 $0.00 $648.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $601.18 $601.18 $624.35 $0.00 $168.80 $0.00 $0.00 $0.00 $0.00 $405.00 $641.52 $648.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002994 EAP Custom 27002994 Kit Percutaneous Introducer BOTH IP/OP $810.00 $599.40 $0.00 $648.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $601.18 $601.18 $624.35 $0.00 $168.80 $0.00 $0.00 $0.00 $0.00 $405.00 $641.52 $648.00 $0.00 $526.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27002995 EAP Custom 27002995 Kanguru Web BOTH IP/OP $64.00 $47.36 $0.00 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $47.50 $47.50 $49.33 $0.00 $13.34 $0.00 $0.00 $0.00 $0.00 $32.00 $50.69 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003005 EAP Custom 27003005 Filter Set 0.22 Micron BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $0.00 $0.00 $0.00 $9.50 $15.05 $15.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003006 EAP Custom 27003006 Tray Foley Preconnected 1 BOTH IP/OP $56.00 $41.44 $0.00 $44.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $41.56 $41.56 $43.16 $0.00 $11.67 $0.00 $0.00 $0.00 $0.00 $28.00 $44.35 $44.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003007 EAP Custom 27003007 Tray Foley Perconnected 1 BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003008 EAP Custom 27003008 Central Line Dressing Tray BOTH IP/OP $49.00 $36.26 $0.00 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $36.37 $36.37 $37.77 $0.00 $10.21 $0.00 $0.00 $0.00 $0.00 $24.50 $38.81 $39.20 $0.00 $31.85 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003028 EAP Custom 27003028 Lumbo-sacral Support BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $25.35 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003040 EAP Custom 27003040 "Walker, For Platform Only" BOTH IP/OP $243.00 $179.82 $0.00 $194.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $180.35 $180.35 $187.30 $0.00 $50.64 $0.00 $0.00 $0.00 $0.00 $121.50 $192.46 $194.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003045 EAP Custom 27003045 Foot Plate-prefb BOTH IP/OP $577.00 $426.98 $0.00 $461.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $428.25 $428.25 $444.75 $0.00 $120.25 $0.00 $0.00 $0.00 $0.00 $288.50 $456.98 $461.60 $0.00 $375.05 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003049 EAP Custom 27003049 Dressing Stick BOTH IP/OP $31.00 $22.94 $0.00 $24.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $23.01 $23.01 $23.89 $0.00 $6.46 $0.00 $0.00 $0.00 $0.00 $15.50 $24.55 $24.80 $0.00 $20.15 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003050 EAP Custom 27003050 Leg Lifter BOTH IP/OP $52.00 $38.48 $0.00 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $38.59 $38.59 $40.08 $0.00 $10.84 $0.00 $0.00 $0.00 $0.00 $26.00 $41.18 $41.60 $0.00 $33.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003051 EAP Custom 27003051 Reacher BOTH IP/OP $117.00 $86.58 $0.00 $93.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $86.84 $86.84 $90.18 $0.00 $24.38 $0.00 $0.00 $0.00 $0.00 $58.50 $92.66 $93.60 $0.00 $76.05 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003053 EAP Custom 27003053 Abduction Pillow BOTH IP/OP $404.00 $298.96 $0.00 $323.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $299.85 $299.85 $311.40 $0.00 $84.19 $0.00 $0.00 $0.00 $0.00 $202.00 $319.97 $323.20 $0.00 $262.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003054 EAP Custom 27003054 Compression Glove BOTH IP/OP $87.00 $64.38 $0.00 $69.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $18.13 $0.00 $0.00 $0.00 $0.00 $43.50 $68.90 $69.60 $0.00 $56.55 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003055 EAP Custom 27003055 Dowel BOTH IP/OP $49.00 $36.26 $0.00 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $36.37 $36.37 $37.77 $0.00 $10.21 $0.00 $0.00 $0.00 $0.00 $24.50 $38.81 $39.20 $0.00 $31.85 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003063 EAP Custom 27003063 Simple Hand-based Splint BOTH IP/OP $52.00 $38.48 $0.00 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $38.59 $38.59 $40.08 $0.00 $10.84 $0.00 $0.00 $0.00 $0.00 $26.00 $41.18 $41.60 $0.00 $33.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003065 EAP Custom 27003065 Custom Finger Splint BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.50 $15.05 $15.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003069 EAP Custom 27003069 Compression Glove BOTH IP/OP $87.00 $64.38 $0.00 $69.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $18.13 $0.00 $0.00 $0.00 $0.00 $43.50 $68.90 $69.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003070 EAP Custom 27003070 Dowel BOTH IP/OP $46.00 $34.04 $0.00 $36.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $34.14 $34.14 $35.46 $0.00 $9.59 $0.00 $0.00 $0.00 $0.00 $23.00 $36.43 $36.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003073 EAP Custom 27003073 Foot Drop Splint BOTH IP/OP $233.00 $172.42 $0.00 $186.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $172.93 $172.93 $179.60 $0.00 $48.56 $0.00 $0.00 $0.00 $0.00 $116.50 $184.54 $186.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003080 EAP Custom 27003080 Custom Finger Splint BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $6.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003081 EAP Custom 27003081 Safe Position Splint BOTH IP/OP $101.00 $74.74 $0.00 $80.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $74.96 $74.96 $77.85 $0.00 $21.05 $0.00 $0.00 $0.00 $0.00 $50.50 $79.99 $80.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003084 EAP Custom 27003084 Compression Glove BOTH IP/OP $87.00 $64.38 $0.00 $69.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $18.13 $0.00 $0.00 $0.00 $0.00 $43.50 $68.90 $69.60 $0.00 $56.55 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003085 EAP Custom 27003085 Dowel BOTH IP/OP $49.00 $36.26 $0.00 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $36.37 $36.37 $37.77 $0.00 $10.21 $0.00 $0.00 $0.00 $0.00 $24.50 $38.81 $39.20 $0.00 $31.85 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003087 EAP Custom 27003087 "Tubigrip, Per Piece" BOTH IP/OP $36.00 $26.64 $0.00 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $26.72 $26.72 $27.75 $0.00 $7.50 $0.00 $0.00 $0.00 $0.00 $18.00 $28.51 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003089 EAP Custom 27003089 Helsper Button BOTH IP/OP $710.00 $525.40 $0.00 $568.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $526.96 $526.96 $547.27 $0.00 $147.96 $0.00 $0.00 $0.00 $0.00 $355.00 $562.32 $568.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003090 EAP Custom 27003090 Laryngectomy Tube BOTH IP/OP $667.00 $493.58 $0.00 $533.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $495.05 $495.05 $514.12 $0.00 $139.00 $0.00 $0.00 $0.00 $0.00 $333.50 $528.26 $533.60 $0.00 $433.55 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003091 EAP Custom 27003091 Inhealth Advan.indwelling Pros BOTH IP/OP $859.00 $635.66 $0.00 $687.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $637.55 $637.55 $662.12 $0.00 $179.02 $0.00 $0.00 $0.00 $0.00 $429.50 $680.33 $687.20 $0.00 $558.35 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003092 EAP Custom 27003092 Inhealth Indwelling Prosthesis BOTH IP/OP $878.00 $649.72 $0.00 $702.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $651.65 $651.65 $676.76 $0.00 $182.98 $0.00 $0.00 $0.00 $0.00 $439.00 $695.38 $702.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003093 EAP Custom 27003093 Inhealth Low Pressure Prosthesis BOTH IP/OP $491.00 $363.34 $0.00 $392.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $364.42 $364.42 $378.46 $0.00 $102.32 $0.00 $0.00 $0.00 $0.00 $245.50 $388.87 $392.80 $0.00 $319.15 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003094 EAP Custom 27003094 Duckbill Prosthesis BOTH IP/OP $309.00 $228.66 $0.00 $247.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $229.34 $229.34 $238.18 $0.00 $64.40 $0.00 $0.00 $0.00 $0.00 $154.50 $244.73 $247.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003095 EAP Custom 27003095 Provox/atox Prosthesis BOTH IP/OP $893.00 $660.82 $0.00 $714.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $662.78 $662.78 $688.32 $0.00 $186.10 $0.00 $0.00 $0.00 $0.00 $446.50 $707.26 $714.40 $0.00 $580.45 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003096 EAP Custom 27003096 Insufflation Test Kit BOTH IP/OP $863.00 $638.62 $0.00 $690.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $640.52 $640.52 $665.20 $0.00 $179.85 $0.00 $0.00 $0.00 $0.00 $431.50 $683.50 $690.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003097 EAP Custom 27003097 Plug Insert BOTH IP/OP $339.00 $250.86 $0.00 $271.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $251.61 $251.61 $261.30 $0.00 $70.65 $0.00 $0.00 $0.00 $0.00 $169.50 $268.49 $271.20 $0.00 $220.35 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003098 EAP Custom 27003098 Catheters BOTH IP/OP $6.00 $4.44 $0.00 $4.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $4.45 $4.45 $4.62 $0.00 $1.25 $0.00 $0.00 $0.00 $0.00 $3.00 $4.75 $4.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003100 EAP Custom 27003100 Barton-mayo Button BOTH IP/OP $849.00 $628.26 $0.00 $679.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $630.13 $630.13 $654.41 $0.00 $176.93 $0.00 $0.00 $0.00 $0.00 $424.50 $672.41 $679.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003101 EAP Custom 27003101 Oral Tubing BOTH IP/OP $5.00 $3.70 $0.00 $4.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $3.71 $3.71 $3.85 $0.00 $1.04 $0.00 $0.00 $0.00 $0.00 $2.50 $3.96 $4.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003103 EAP Custom 27003103 Occult Blood Supply BOTH IP/OP $42.00 $31.08 $0.00 $33.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $31.17 $31.17 $32.37 $0.00 $8.75 $0.00 $0.00 $0.00 $0.00 $21.00 $33.26 $33.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003104 EAP Custom 27003104 Interceed Sup/admin BOTH IP/OP $424.00 $313.76 $0.00 $339.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $314.69 $314.69 $326.82 $0.00 $88.36 $0.00 $0.00 $0.00 $0.00 $212.00 $335.81 $339.20 $0.00 $275.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003105 EAP Custom 27003105 Pudendal Kit BOTH IP/OP $102.00 $75.48 $0.00 $81.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $75.70 $75.70 $78.62 $0.00 $21.26 $0.00 $0.00 $0.00 $0.00 $51.00 $80.78 $81.60 $0.00 $66.30 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003108 EAP Custom 27003108 Dressing Hemostasis BOTH IP/OP $441.00 $326.34 $0.00 $352.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $327.31 $327.31 $339.92 $0.00 $91.90 $0.00 $0.00 $0.00 $0.00 $220.50 $349.27 $352.80 $0.00 $286.65 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003113 EAP Custom 27003113 Tegaderm Dressing BOTH IP/OP $51.00 $37.74 $0.00 $40.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $37.85 $37.85 $39.31 $0.00 $10.63 $0.00 $0.00 $0.00 $0.00 $25.50 $40.39 $40.80 $0.00 $33.15 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003114 EAP Custom 27003114 Tegaderm Dressing BOTH IP/OP $20.00 $14.80 $0.00 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.84 $14.84 $15.42 $0.00 $4.17 $0.00 $0.00 $0.00 $0.00 $10.00 $15.84 $16.00 $0.00 $13.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003115 EAP Custom 27003115 "Wound Gel, Carrington" BOTH IP/OP $103.00 $76.22 $0.00 $82.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $76.45 $76.45 $79.39 $0.00 $21.47 $0.00 $0.00 $0.00 $0.00 $51.50 $81.58 $82.40 $0.00 $66.95 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003116 EAP Custom 27003116 "Kara Klenz, Wound Cleanser" BOTH IP/OP $102.00 $75.48 $0.00 $81.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $75.70 $75.70 $78.62 $0.00 $21.26 $0.00 $0.00 $0.00 $0.00 $51.00 $80.78 $81.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003117 EAP Custom 27003117 "Little Ones, White Collar 4x4" BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $25.35 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003118 EAP Custom 27003118 "Pouch, Cut To Fit, Little Ones" BOTH IP/OP $31.00 $22.94 $0.00 $24.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $23.01 $23.01 $23.89 $0.00 $6.46 $0.00 $0.00 $0.00 $0.00 $15.50 $24.55 $24.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003119 EAP Custom 27003119 "Pouch, Active Life" BOTH IP/OP $36.00 $26.64 $0.00 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $26.72 $26.72 $27.75 $0.00 $7.50 $0.00 $0.00 $0.00 $0.00 $18.00 $28.51 $28.80 $0.00 $23.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003120 EAP Custom 27003120 "Flange, Sur-fit" BOTH IP/OP $42.00 $31.08 $0.00 $33.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $31.17 $31.17 $32.37 $0.00 $8.75 $0.00 $0.00 $0.00 $0.00 $21.00 $33.26 $33.60 $0.00 $27.30 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003121 EAP Custom 27003121 Pouch Drainable Opaque BOTH IP/OP $20.00 $14.80 $0.00 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.84 $14.84 $15.42 $0.00 $4.17 $0.00 $0.00 $0.00 $0.00 $10.00 $15.84 $16.00 $0.00 $13.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003124 EAP Custom 27003124 Barrier With Convexity BOTH IP/OP $34.00 $25.16 $0.00 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $25.23 $25.23 $26.21 $0.00 $7.09 $0.00 $0.00 $0.00 $0.00 $17.00 $26.93 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003127 EAP Custom 27003127 High Flow Continuous BOTH IP/OP $406.00 $300.44 $0.00 $324.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $301.33 $301.33 $312.94 $0.00 $84.61 $0.00 $0.00 $0.00 $0.00 $203.00 $321.55 $324.80 $0.00 $263.90 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003128 EAP Custom 27003128 Low Flow Continous BOTH IP/OP $406.00 $300.44 $0.00 $324.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $301.33 $301.33 $312.94 $0.00 $84.61 $0.00 $0.00 $0.00 $0.00 $203.00 $321.55 $324.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003130 EAP Custom 27003130 Mdi Spacer Supply BOTH IP/OP $195.00 $144.30 $0.00 $156.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $144.73 $144.73 $150.31 $0.00 $40.64 $0.00 $0.00 $0.00 $0.00 $97.50 $154.44 $156.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003131 EAP Custom 27003131 Occult Blood Supply BOTH IP/OP $44.00 $32.56 $0.00 $35.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $32.66 $32.66 $33.92 $0.00 $9.17 $0.00 $0.00 $0.00 $0.00 $22.00 $34.85 $35.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003132 EAP Custom 27003132 Wrist Brace BOTH IP/OP $60.00 $44.40 $0.00 $48.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $44.53 $44.53 $46.25 $0.00 $12.50 $0.00 $0.00 $0.00 $0.00 $30.00 $47.52 $48.00 $0.00 $39.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003134 EAP HCPCS J2798 Mirena (iud) Kit BOTH IP/OP $994.00 $735.56 $0.00 $795.20 $0.00 $0.00 $0.00 $0.00 $0.00 $207.17 $0.00 $0.00 $0.00 $10.69 $12.56 $6.95 $587.95 $587.95 $0.00 $497.00 $787.25 $795.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27003153 EAP Custom 27003153 Nuva Ring Fp BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27004266 EAP Custom 27004266 13.5mm/3.2mm Wire Guide BOTH IP/OP "$1,747.00 " "$1,292.78" $0.00 "$1,397.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,296.62" "$1,296.62" "$1,346.59" $0.00 $364.07 $0.00 $0.00 $0.00 $0.00 $873.50 "$1,383.62" "$1,397.60" $0.00 "$1,135.55" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27004311 EAP Custom 27004311 Long Forceps 230mm BOTH IP/OP "$2,779.00 " "$2,056.46" $0.00 "$2,223.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,062.57" "$2,062.57" "$2,142.05" $0.00 $579.14 $0.00 $0.00 $0.00 $0.00 "$1,389.50" "$2,200.97" "$2,223.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27004327 EAP Custom 27004327 Medium Wire Cutter 160mm BOTH IP/OP "$4,148.00 " "$3,069.52" $0.00 "$3,318.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$3,078.65" "$3,078.65" "$3,197.28" $0.00 $864.44 $0.00 $0.00 $0.00 $0.00 "$2,074.00" "$3,285.22" "$3,318.40" $0.00 "$2,696.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27004640 EAP Custom 27004640 Large Anchoring Hook 30mm BOTH IP/OP $509.00 $376.66 $0.00 $407.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $377.78 $377.78 $392.34 $0.00 $106.08 $0.00 $0.00 $0.00 $0.00 $254.50 $403.13 $407.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007212 EAP Custom 27007212 10.0mm Circular Saw 28mm BOTH IP/OP $290.00 $214.60 $0.00 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $215.24 $215.24 $223.53 $0.00 $60.44 $0.00 $0.00 $0.00 $0.00 $145.00 $229.68 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007213 EAP Custom 27007213 12.0mm Circular Saw 28mm BOTH IP/OP $290.00 $214.60 $0.00 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $215.24 $215.24 $223.53 $0.00 $60.44 $0.00 $0.00 $0.00 $0.00 $145.00 $229.68 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007214 EAP Custom 27007214 15.0mm Circular Saw 28mm BOTH IP/OP $290.00 $214.60 $0.00 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $215.24 $215.24 $223.53 $0.00 $60.44 $0.00 $0.00 $0.00 $0.00 $145.00 $229.68 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007219 EAP Custom 27007219 Tibial Nail Driving Adaptor BOTH IP/OP "$4,208.00 " "$3,113.92" $0.00 "$3,366.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$3,123.18" "$3,123.18" "$3,243.53" $0.00 $876.95 $0.00 $0.00 $0.00 $0.00 "$2,104.00" "$3,332.74" "$3,366.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007220 EAP Custom 27007220 Saw Blade 27mm Width 50mm/0.6m BOTH IP/OP $255.00 $188.70 $0.00 $204.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $189.26 $189.26 $196.55 $0.00 $53.14 $0.00 $0.00 $0.00 $0.00 $127.50 $201.96 $204.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007221 EAP Custom 27007221 Saw Blade 10mm Width 25mm/0.6m BOTH IP/OP $255.00 $188.70 $0.00 $204.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $189.26 $189.26 $196.55 $0.00 $53.14 $0.00 $0.00 $0.00 $0.00 $127.50 $201.96 $204.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007222 EAP Custom 27007222 Saw Blade 10mm Width 50mm/0.6m BOTH IP/OP $255.00 $188.70 $0.00 $204.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $189.26 $189.26 $196.55 $0.00 $53.14 $0.00 $0.00 $0.00 $0.00 $127.50 $201.96 $204.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007223 EAP Custom 27007223 Saw Blade 20mm Width 50mm/0.6m BOTH IP/OP $255.00 $188.70 $0.00 $204.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $189.26 $189.26 $196.55 $0.00 $53.14 $0.00 $0.00 $0.00 $0.00 $127.50 $201.96 $204.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007224 EAP Custom 27007224 Saw Blade 19mm Width 70mm/1.0m BOTH IP/OP $255.00 $188.70 $0.00 $204.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $189.26 $189.26 $196.55 $0.00 $53.14 $0.00 $0.00 $0.00 $0.00 $127.50 $201.96 $204.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007225 EAP Custom 27007225 Saw Blade 19mm Width 95mm/0.9m BOTH IP/OP $325.00 $240.50 $0.00 $260.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $241.22 $241.22 $250.51 $0.00 $67.73 $0.00 $0.00 $0.00 $0.00 $162.50 $257.40 $260.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007226 EAP Custom 27007226 Saw Blade 25mm Width 95mm/0.9 BOTH IP/OP $325.00 $240.50 $0.00 $260.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $241.22 $241.22 $250.51 $0.00 $67.73 $0.00 $0.00 $0.00 $0.00 $162.50 $257.40 $260.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007227 EAP Custom 27007227 Saw Blade 25mm Width 60mm/0.9 BOTH IP/OP $325.00 $240.50 $0.00 $260.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $241.22 $241.22 $250.51 $0.00 $67.73 $0.00 $0.00 $0.00 $0.00 $162.50 $257.40 $260.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007228 EAP Custom 27007228 Saw Blade 18mm Width 70mm/1.2 BOTH IP/OP $255.00 $188.70 $0.00 $204.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $189.26 $189.26 $196.55 $0.00 $53.14 $0.00 $0.00 $0.00 $0.00 $127.50 $201.96 $204.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007229 EAP Custom 27007229 Saw Blade 19mm Width 95mm/1.25 BOTH IP/OP $325.00 $240.50 $0.00 $260.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $241.22 $241.22 $250.51 $0.00 $67.73 $0.00 $0.00 $0.00 $0.00 $162.50 $257.40 $260.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007230 EAP Custom 27007230 Saw Blade 25mm Width 95mm/1.25 BOTH IP/OP $325.00 $240.50 $0.00 $260.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $241.22 $241.22 $250.51 $0.00 $67.73 $0.00 $0.00 $0.00 $0.00 $162.50 $257.40 $260.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007231 EAP Custom 27007231 Saw Blade 19mm Width 95mm/1.4 BOTH IP/OP $325.00 $240.50 $0.00 $260.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $241.22 $241.22 $250.51 $0.00 $67.73 $0.00 $0.00 $0.00 $0.00 $162.50 $257.40 $260.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007232 EAP Custom 27007232 Saw Blade 25mm Width 95mm/1.4 BOTH IP/OP $325.00 $240.50 $0.00 $260.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $241.22 $241.22 $250.51 $0.00 $67.73 $0.00 $0.00 $0.00 $0.00 $162.50 $257.40 $260.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007233 EAP Custom 27007233 Saw Blade 12.5mm Wdth 90mm/0.9 BOTH IP/OP $325.00 $240.50 $0.00 $260.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $241.22 $241.22 $250.51 $0.00 $67.73 $0.00 $0.00 $0.00 $0.00 $162.50 $257.40 $260.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007234 EAP Custom 27007234 Saw Blade 14mm Width 50mm/0.6 BOTH IP/OP $255.00 $188.70 $0.00 $204.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $189.26 $189.26 $196.55 $0.00 $53.14 $0.00 $0.00 $0.00 $0.00 $127.50 $201.96 $204.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007235 EAP Custom 27007235 Saw Blade 27mm Width 70mm/0.8 BOTH IP/OP $255.00 $188.70 $0.00 $204.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $189.26 $189.26 $196.55 $0.00 $53.14 $0.00 $0.00 $0.00 $0.00 $127.50 $201.96 $204.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007236 EAP Custom 27007236 Saw Blade 50mm Width 70mm/0.8 BOTH IP/OP $255.00 $188.70 $0.00 $204.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $189.26 $189.26 $196.55 $0.00 $53.14 $0.00 $0.00 $0.00 $0.00 $127.50 $201.96 $204.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007237 EAP Custom 27007237 Saw Blade 27mm Width 70mm/1.0 BOTH IP/OP $255.00 $188.70 $0.00 $204.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $189.26 $189.26 $196.55 $0.00 $53.14 $0.00 $0.00 $0.00 $0.00 $127.50 $201.96 $204.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007238 EAP Custom 27007238 Saw Blade 27mm Width 70mm/1.2 BOTH IP/OP $255.00 $188.70 $0.00 $204.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $189.26 $189.26 $196.55 $0.00 $53.14 $0.00 $0.00 $0.00 $0.00 $127.50 $201.96 $204.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007239 EAP Custom 27007239 Saw Blade 6mm Width 25mm/0.6m BOTH IP/OP $255.00 $188.70 $0.00 $204.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $189.26 $189.26 $196.55 $0.00 $53.14 $0.00 $0.00 $0.00 $0.00 $127.50 $201.96 $204.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007240 EAP Custom 27007240 Saw Blade 14mm Width 25mm/0.6m BOTH IP/OP $255.00 $188.70 $0.00 $204.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $189.26 $189.26 $196.55 $0.00 $53.14 $0.00 $0.00 $0.00 $0.00 $127.50 $201.96 $204.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007241 EAP Custom 27007241 Saw Blade 6mm Width 10mm/0.4mm BOTH IP/OP $267.00 $197.58 $0.00 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $198.17 $198.17 $205.80 $0.00 $55.64 $0.00 $0.00 $0.00 $0.00 $133.50 $211.46 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007242 EAP Custom 27007242 Saw Blade 6mm Width 10mm/0.4mm BOTH IP/OP $290.00 $214.60 $0.00 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $215.24 $215.24 $223.53 $0.00 $60.44 $0.00 $0.00 $0.00 $0.00 $145.00 $229.68 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007243 EAP Custom 27007243 Saw Blade 10mm Width 10mm/0.4m BOTH IP/OP $267.00 $197.58 $0.00 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $198.17 $198.17 $205.80 $0.00 $55.64 $0.00 $0.00 $0.00 $0.00 $133.50 $211.46 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007244 EAP Custom 27007244 Saw Blade 10mm Width 10mm/0.4m BOTH IP/OP $290.00 $214.60 $0.00 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $215.24 $215.24 $223.53 $0.00 $60.44 $0.00 $0.00 $0.00 $0.00 $145.00 $229.68 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007245 EAP Custom 27007245 Saw Blade 16mm Width 10mm/0.4m BOTH IP/OP $267.00 $197.58 $0.00 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $198.17 $198.17 $205.80 $0.00 $55.64 $0.00 $0.00 $0.00 $0.00 $133.50 $211.46 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007246 EAP Custom 27007246 Saw Blade 16mm Width 10mm/0.4m BOTH IP/OP $290.00 $214.60 $0.00 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $215.24 $215.24 $223.53 $0.00 $60.44 $0.00 $0.00 $0.00 $0.00 $145.00 $229.68 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007247 EAP Custom 27007247 Saw Blade 4mm Width 15mm/0.4mm BOTH IP/OP $267.00 $197.58 $0.00 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $198.17 $198.17 $205.80 $0.00 $55.64 $0.00 $0.00 $0.00 $0.00 $133.50 $211.46 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007248 EAP Custom 27007248 Saw Blade 4mm Width 15mm/0.4m BOTH IP/OP $290.00 $214.60 $0.00 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $215.24 $215.24 $223.53 $0.00 $60.44 $0.00 $0.00 $0.00 $0.00 $145.00 $229.68 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007249 EAP Custom 27007249 Saw Blade 8mm Width 20mm/0.4mm BOTH IP/OP $267.00 $197.58 $0.00 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $198.17 $198.17 $205.80 $0.00 $55.64 $0.00 $0.00 $0.00 $0.00 $133.50 $211.46 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007250 EAP Custom 27007250 Saw Blade 8mm Width 20mm/0.4 BOTH IP/OP $290.00 $214.60 $0.00 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $215.24 $215.24 $223.53 $0.00 $60.44 $0.00 $0.00 $0.00 $0.00 $145.00 $229.68 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007251 EAP Custom 27007251 Saw Blade 12mm Width 20mm/0.4 BOTH IP/OP $267.00 $197.58 $0.00 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $198.17 $198.17 $205.80 $0.00 $55.64 $0.00 $0.00 $0.00 $0.00 $133.50 $211.46 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007252 EAP Custom 27007252 Saw Blade 12mm Width 20mm/0.4 BOTH IP/OP $290.00 $214.60 $0.00 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $215.24 $215.24 $223.53 $0.00 $60.44 $0.00 $0.00 $0.00 $0.00 $145.00 $229.68 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007253 EAP Custom 27007253 Saw Blade 6mm Width 30mm/0.4 BOTH IP/OP $267.00 $197.58 $0.00 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $198.17 $198.17 $205.80 $0.00 $55.64 $0.00 $0.00 $0.00 $0.00 $133.50 $211.46 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007254 EAP Custom 27007254 Saw Blade 6mm Width 30mm/0.4 BOTH IP/OP $290.00 $214.60 $0.00 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $215.24 $215.24 $223.53 $0.00 $60.44 $0.00 $0.00 $0.00 $0.00 $145.00 $229.68 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007255 EAP Custom 27007255 Saw Blade 10mm Width 30mm/0.4 BOTH IP/OP $267.00 $197.58 $0.00 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $198.17 $198.17 $205.80 $0.00 $55.64 $0.00 $0.00 $0.00 $0.00 $133.50 $211.46 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007256 EAP Custom 27007256 Saw Blade 10mm Width 30mm/0.4 BOTH IP/OP $290.00 $214.60 $0.00 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $215.24 $215.24 $223.53 $0.00 $60.44 $0.00 $0.00 $0.00 $0.00 $145.00 $229.68 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007257 EAP Custom 27007257 Saw Blade 6mm Width 25mm/0.6 BOTH IP/OP $267.00 $197.58 $0.00 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $198.17 $198.17 $205.80 $0.00 $55.64 $0.00 $0.00 $0.00 $0.00 $133.50 $211.46 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007258 EAP Custom 27007258 Saw Blade 6mm Width 25mm/0.6 BOTH IP/OP $290.00 $214.60 $0.00 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $215.24 $215.24 $223.53 $0.00 $60.44 $0.00 $0.00 $0.00 $0.00 $145.00 $229.68 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007259 EAP Custom 27007259 Saw Blade 10mm Width 25mm/0.6 BOTH IP/OP $267.00 $197.58 $0.00 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $198.17 $198.17 $205.80 $0.00 $55.64 $0.00 $0.00 $0.00 $0.00 $133.50 $211.46 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007260 EAP Custom 27007260 Saw Blade 10mm Width 25mm/0.6 BOTH IP/OP $290.00 $214.60 $0.00 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $215.24 $215.24 $223.53 $0.00 $60.44 $0.00 $0.00 $0.00 $0.00 $145.00 $229.68 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007261 EAP Custom 27007261 Saw Blade 14mm Width 25mm/0.6 BOTH IP/OP $267.00 $197.58 $0.00 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $198.17 $198.17 $205.80 $0.00 $55.64 $0.00 $0.00 $0.00 $0.00 $133.50 $211.46 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007262 EAP Custom 27007262 Saw Blade 14mm Width 25mm/0.6 BOTH IP/OP $290.00 $214.60 $0.00 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $215.24 $215.24 $223.53 $0.00 $60.44 $0.00 $0.00 $0.00 $0.00 $145.00 $229.68 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007263 EAP Custom 27007263 Saw Blade 10mm Width 50mm/0.6 BOTH IP/OP $267.00 $197.58 $0.00 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $198.17 $198.17 $205.80 $0.00 $55.64 $0.00 $0.00 $0.00 $0.00 $133.50 $211.46 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007264 EAP Custom 27007264 Saw Bld 10 Wdth 50/0.6cut Thk BOTH IP/OP $290.00 $214.60 $0.00 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $215.24 $215.24 $223.53 $0.00 $60.44 $0.00 $0.00 $0.00 $0.00 $145.00 $229.68 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007265 EAP Custom 27007265 Saw Bld 14 Wdth 50/0.6cut Thk BOTH IP/OP $267.00 $197.58 $0.00 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $198.17 $198.17 $205.80 $0.00 $55.64 $0.00 $0.00 $0.00 $0.00 $133.50 $211.46 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007266 EAP Custom 27007266 Saw Bld 14 Wdth 50/0.6 Cut Thk BOTH IP/OP $290.00 $214.60 $0.00 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $215.24 $215.24 $223.53 $0.00 $60.44 $0.00 $0.00 $0.00 $0.00 $145.00 $229.68 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007267 EAP Custom 27007267 Saw Bld 20 Wdth 50/0.6 Cut Thk BOTH IP/OP $267.00 $197.58 $0.00 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $198.17 $198.17 $205.80 $0.00 $55.64 $0.00 $0.00 $0.00 $0.00 $133.50 $211.46 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007268 EAP Custom 27007268 Saw Bld 20 Wdth 50/0.6 Cut Thk BOTH IP/OP $290.00 $214.60 $0.00 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $215.24 $215.24 $223.53 $0.00 $60.44 $0.00 $0.00 $0.00 $0.00 $145.00 $229.68 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007269 EAP Custom 27007269 Saw Bld 27 Wdth 50/0.6 Cut Thk BOTH IP/OP $267.00 $197.58 $0.00 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $198.17 $198.17 $205.80 $0.00 $55.64 $0.00 $0.00 $0.00 $0.00 $133.50 $211.46 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007270 EAP Custom 27007270 Saw Bld 27 Wdth 50/0.6 Cut Thk BOTH IP/OP $290.00 $214.60 $0.00 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $215.24 $215.24 $223.53 $0.00 $60.44 $0.00 $0.00 $0.00 $0.00 $145.00 $229.68 $232.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007451 EAP Custom 27007451 "Peg Fully Thread 2.5mm, 24mm" BOTH IP/OP $398.00 $294.52 $0.00 $318.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $295.40 $295.40 $306.78 $0.00 $82.94 $0.00 $0.00 $0.00 $0.00 $199.00 $315.22 $318.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007489 EAP Custom 27007489 Mini-clip Str 3mm BOTH IP/OP "$1,693.00 " "$1,252.82" $0.00 "$1,354.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,256.54" "$1,256.54" "$1,304.96" $0.00 $352.82 $0.00 $0.00 $0.00 $0.00 $846.50 "$1,340.86" "$1,354.40" $0.00 "$1,100.45" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007557 EAP Custom 27007557 Screwdriver Blade BOTH IP/OP "$1,268.00 " $938.32 $0.00 "$1,014.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $941.11 $941.11 $977.37 $0.00 $264.25 $0.00 $0.00 $0.00 $0.00 $634.00 "$1,004.26" "$1,014.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007632 EAP Custom 27007632 Rotary Mixer BOTH IP/OP "$8,539.00 " "$6,318.86" $0.00 "$6,831.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$6,581.86" $0.00 "$1,779.53" $0.00 $0.00 $0.00 $0.00 "$4,269.50" "$6,762.89" "$6,831.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007633 EAP Custom 27007633 Srs? Fast Set Putty 3cc Steril BOTH IP/OP "$3,760.00 " "$2,782.40" $0.00 "$3,008.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,790.67" "$2,790.67" "$2,898.21" $0.00 $783.58 $0.00 $0.00 $0.00 $0.00 "$1,880.00" "$2,977.92" "$3,008.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007634 EAP Custom 27007634 Nor? Srs? Bne Void Fill Ro 3cc BOTH IP/OP "$3,852.00 " "$2,850.48" $0.00 "$3,081.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,858.95" "$2,858.95" "$2,969.12" $0.00 $802.76 $0.00 $0.00 $0.00 $0.00 "$1,926.00" "$3,050.78" "$3,081.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007635 EAP Custom 27007635 Srs? Fast Set Putty 5cc Steril BOTH IP/OP "$6,218.00 " "$4,601.32" $0.00 "$4,974.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$4,792.83" $0.00 "$1,295.83" $0.00 $0.00 $0.00 $0.00 "$3,109.00" "$4,924.66" "$4,974.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007636 EAP Custom 27007636 Nor? Srs? Bne Void Fill Ro 5cc BOTH IP/OP "$6,310.00 " "$4,669.40" $0.00 "$5,048.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$4,863.75" $0.00 "$1,315.00" $0.00 $0.00 $0.00 $0.00 "$3,155.00" "$4,997.52" "$5,048.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007637 EAP Custom 27007637 Srs? Fast Set Putty 10cc Steri BOTH IP/OP "$12,321.00 " "$9,117.54" $0.00 "$9,856.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$9,497.03" $0.00 "$2,567.70" $0.00 $0.00 $0.00 $0.00 "$6,160.50" "$9,758.23" "$9,856.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007638 EAP Custom 27007638 Nor? Srs? Bne Vd Fill Ro Mx 10 BOTH IP/OP "$12,413.00 " "$9,185.62" $0.00 "$9,930.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$9,567.94" $0.00 "$2,586.87" $0.00 $0.00 $0.00 $0.00 "$6,206.50" "$9,831.10" "$9,930.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007639 EAP Custom 27007639 Srs? Fast Set Putty 15cc Ster BOTH IP/OP "$18,167.00 " "$13,443.58" $0.00 "$14,533.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$14,003.12" $0.00 "$3,786.00" $0.00 $0.00 $0.00 $0.00 "$9,083.50" "$14,388.26" "$14,533.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007640 EAP Custom 27007640 Pressure Measurement BOTH IP/OP $904.00 $668.96 $0.00 $723.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $670.95 $670.95 $696.80 $0.00 $188.39 $0.00 $0.00 $0.00 $0.00 $452.00 $715.97 $723.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007719 EAP Custom 27007719 Univ Lock Troch Stab Pl 131mm BOTH IP/OP "$2,620.00 " "$1,938.80" $0.00 "$2,096.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,944.56" "$1,944.56" "$2,019.50" $0.00 $546.01 $0.00 $0.00 $0.00 $0.00 "$1,310.00" "$2,075.04" "$2,096.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007749 EAP Custom 27007749 T15/2.5m Hex Cerclage But- Ste BOTH IP/OP $652.00 $482.48 $0.00 $521.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $483.91 $483.91 $502.56 $0.00 $135.88 $0.00 $0.00 $0.00 $0.00 $326.00 $516.38 $521.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007795 EAP Custom 27007795 Swans Bur S?2.0m Hd Lgh 6.3mm BOTH IP/OP $366.00 $270.84 $0.00 $292.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $271.65 $271.65 $282.11 $0.00 $76.27 $0.00 $0.00 $0.00 $0.00 $183.00 $289.87 $292.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007796 EAP Custom 27007796 Swans Bur M?2.0m Hd Lgh 6.3mm BOTH IP/OP $366.00 $270.84 $0.00 $292.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $271.65 $271.65 $282.11 $0.00 $76.27 $0.00 $0.00 $0.00 $0.00 $183.00 $289.87 $292.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007797 EAP Custom 27007797 Swans Bur L?2.0m Hd Lgh 6.3mm BOTH IP/OP $366.00 $270.84 $0.00 $292.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $271.65 $271.65 $282.11 $0.00 $76.27 $0.00 $0.00 $0.00 $0.00 $183.00 $289.87 $292.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007798 EAP Custom 27007798 Swans Bur S?3.0m Hd Lgh 9.7mm BOTH IP/OP $366.00 $270.84 $0.00 $292.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $271.65 $271.65 $282.11 $0.00 $76.27 $0.00 $0.00 $0.00 $0.00 $183.00 $289.87 $292.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007799 EAP Custom 27007799 Swans Bur M?3.0m Hd Lgh 9.7mm BOTH IP/OP $366.00 $270.84 $0.00 $292.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $271.65 $271.65 $282.11 $0.00 $76.27 $0.00 $0.00 $0.00 $0.00 $183.00 $289.87 $292.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007800 EAP Custom 27007800 Swans Bur L?3.0m Hd Lgh 9.7mm BOTH IP/OP $366.00 $270.84 $0.00 $292.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $271.65 $271.65 $282.11 $0.00 $76.27 $0.00 $0.00 $0.00 $0.00 $183.00 $289.87 $292.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007801 EAP Custom 27007801 Swans Bur S?4.0m Hd Lgh 12.7mm BOTH IP/OP $366.00 $270.84 $0.00 $292.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $271.65 $271.65 $282.11 $0.00 $76.27 $0.00 $0.00 $0.00 $0.00 $183.00 $289.87 $292.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007802 EAP Custom 27007802 Swans Bur M?4.0m Hd Lgh 12.7mm BOTH IP/OP $148.00 $109.52 $0.00 $118.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $109.85 $109.85 $114.08 $0.00 $30.84 $0.00 $0.00 $0.00 $0.00 $74.00 $117.22 $118.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007803 EAP Custom 27007803 Swans Bur L?4.0m Hd Lgh 12.7mm BOTH IP/OP $366.00 $270.84 $0.00 $292.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $271.65 $271.65 $282.11 $0.00 $76.27 $0.00 $0.00 $0.00 $0.00 $183.00 $289.87 $292.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007810 EAP Custom 27007810 Swans Bur S?5.0m Hd Lgh 15.8mm BOTH IP/OP $366.00 $270.84 $0.00 $292.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $271.65 $271.65 $282.11 $0.00 $76.27 $0.00 $0.00 $0.00 $0.00 $183.00 $289.87 $292.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007811 EAP Custom 27007811 Swans Bur M?5.0m Hd Lgh 15.8mm BOTH IP/OP $366.00 $270.84 $0.00 $292.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $271.65 $271.65 $282.11 $0.00 $76.27 $0.00 $0.00 $0.00 $0.00 $183.00 $289.87 $292.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007812 EAP Custom 27007812 Swans Bur L?5.0m Hd Lgh 15.8mm BOTH IP/OP $366.00 $270.84 $0.00 $292.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $271.65 $271.65 $282.11 $0.00 $76.27 $0.00 $0.00 $0.00 $0.00 $183.00 $289.87 $292.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007840 EAP Custom 27007840 Lindeman Rmer Lgh 45m ?2.3m BOTH IP/OP $325.00 $240.50 $0.00 $260.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $241.22 $241.22 $250.51 $0.00 $67.73 $0.00 $0.00 $0.00 $0.00 $162.50 $257.40 $260.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007853 EAP Custom 27007853 Saw Blade F/sagittal Saw BOTH IP/OP $325.00 $240.50 $0.00 $260.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $241.22 $241.22 $250.51 $0.00 $67.73 $0.00 $0.00 $0.00 $0.00 $162.50 $257.40 $260.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007854 EAP Custom 27007854 Saw Blde Cresc F/oscillat Saw BOTH IP/OP $366.00 $270.84 $0.00 $292.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $271.65 $271.65 $282.11 $0.00 $76.27 $0.00 $0.00 $0.00 $0.00 $183.00 $289.87 $292.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007864 EAP Custom 27007864 Tibial Nail-ex Insertion Handl BOTH IP/OP "$5,201.00 " "$3,848.74" $0.00 "$4,160.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$3,860.18" "$3,860.18" "$4,008.93" $0.00 "$1,083.89" $0.00 $0.00 $0.00 $0.00 "$2,600.50" "$4,119.19" "$4,160.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007865 EAP Custom 27007865 Rad Ruler Ti Cannul Fem Nails BOTH IP/OP "$1,330.00 " $984.20 $0.00 "$1,064.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $987.13 $987.13 "$1,025.16" $0.00 $277.17 $0.00 $0.00 $0.00 $0.00 $665.00 "$1,053.36" "$1,064.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007866 EAP Custom 27007866 Rad Ruler Ti Cannul Tib Nails BOTH IP/OP "$1,330.00 " $984.20 $0.00 "$1,064.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $987.13 $987.13 "$1,025.16" $0.00 $277.17 $0.00 $0.00 $0.00 $0.00 $665.00 "$1,053.36" "$1,064.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007867 EAP Custom 27007867 Rad Ruler Ti Cannul Hum Nails BOTH IP/OP "$1,330.00 " $984.20 $0.00 "$1,064.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $987.13 $987.13 "$1,025.16" $0.00 $277.17 $0.00 $0.00 $0.00 $0.00 $665.00 "$1,053.36" "$1,064.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007868 EAP Custom 27007868 Rad Canal Wdth Estimat Im Nail BOTH IP/OP "$1,330.00 " $984.20 $0.00 "$1,064.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $987.13 $987.13 "$1,025.16" $0.00 $277.17 $0.00 $0.00 $0.00 $0.00 $665.00 "$1,053.36" "$1,064.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007869 EAP Custom 27007869 Hold Devic Gde Wire & Ream Rod BOTH IP/OP "$3,375.00 " "$2,497.50" $0.00 "$2,700.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,504.93" "$2,504.93" "$2,601.45" $0.00 $703.35 $0.00 $0.00 $0.00 $0.00 "$1,687.50" "$2,673.00" "$2,700.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007871 EAP Custom 27007871 15.0 Cannul Drl Bit Lg Qc/280m BOTH IP/OP "$1,969.00 " "$1,457.06" $0.00 "$1,575.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,461.39" "$1,461.39" "$1,517.71" $0.00 $410.34 $0.00 $0.00 $0.00 $0.00 $984.50 "$1,559.45" "$1,575.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007872 EAP Custom 27007872 17.0m Cannul Drl Bit Lg Qc/280 BOTH IP/OP "$2,461.00 " "$1,821.14" $0.00 "$1,968.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,826.55" "$1,826.55" "$1,896.94" $0.00 $512.87 $0.00 $0.00 $0.00 $0.00 "$1,230.50" "$1,949.11" "$1,968.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007873 EAP Custom 27007873 13.0mm Protection Sleeve BOTH IP/OP "$1,490.00 " "$1,102.60" $0.00 "$1,192.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,105.88" "$1,105.88" "$1,148.49" $0.00 $310.52 $0.00 $0.00 $0.00 $0.00 $745.00 "$1,180.08" "$1,192.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007874 EAP Custom 27007874 13.0/3.2 Wire Gude W/ Troc Tip BOTH IP/OP $591.00 $437.34 $0.00 $472.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $438.64 $438.64 $455.54 $0.00 $123.16 $0.00 $0.00 $0.00 $0.00 $295.50 $468.07 $472.80 $0.00 $384.15 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007875 EAP Custom 27007875 13 Flex Can Drl Bit Lg Qc/465 BOTH IP/OP "$2,762.00 " "$2,043.88" $0.00 "$2,209.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,049.96" "$2,049.96" "$2,128.95" $0.00 $575.60 $0.00 $0.00 $0.00 $0.00 "$1,381.00" "$2,187.50" "$2,209.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007876 EAP Custom 27007876 13 Flex Can Drl Bit Lg Qc/465 BOTH IP/OP "$2,891.00 " "$2,139.34" $0.00 "$2,312.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,145.70" "$2,145.70" "$2,228.38" $0.00 $602.48 $0.00 $0.00 $0.00 $0.00 "$1,445.50" "$2,289.67" "$2,312.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007877 EAP Custom 27007877 12.0mm Protection Sleeve BOTH IP/OP "$1,490.00 " "$1,102.60" $0.00 "$1,192.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,105.88" "$1,105.88" "$1,148.49" $0.00 $310.52 $0.00 $0.00 $0.00 $0.00 $745.00 "$1,180.08" "$1,192.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007878 EAP Custom 27007878 12.0 Cannul Drl Bit Lg Qc/190 BOTH IP/OP "$2,211.00 " "$1,636.14" $0.00 "$1,768.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,641.00" "$1,641.00" "$1,704.24" $0.00 $460.77 $0.00 $0.00 $0.00 $0.00 "$1,105.50" "$1,751.11" "$1,768.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007879 EAP Custom 27007879 10.0mm Protection Sleeve BOTH IP/OP "$1,490.00 " "$1,102.60" $0.00 "$1,192.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,105.88" "$1,105.88" "$1,148.49" $0.00 $310.52 $0.00 $0.00 $0.00 $0.00 $745.00 "$1,180.08" "$1,192.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007880 EAP Custom 27007880 10.0mm Cannulated Awl BOTH IP/OP "$1,747.00 " "$1,292.78" $0.00 "$1,397.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,296.62" "$1,296.62" "$1,346.59" $0.00 $364.07 $0.00 $0.00 $0.00 $0.00 $873.50 "$1,383.62" "$1,397.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007881 EAP Custom 27007881 12.0mm Cannulated Awl BOTH IP/OP "$1,778.00 " "$1,315.72" $0.00 "$1,422.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,319.63" "$1,319.63" "$1,370.48" $0.00 $370.54 $0.00 $0.00 $0.00 $0.00 $889.00 "$1,408.18" "$1,422.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007882 EAP Custom 27007882 14.0mm Cannulated Awl BOTH IP/OP "$1,855.00 " "$1,372.70" $0.00 "$1,484.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,376.78" "$1,376.78" "$1,429.83" $0.00 $386.58 $0.00 $0.00 $0.00 $0.00 $927.50 "$1,469.16" "$1,484.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007884 EAP Custom 27007884 Standard Insertion Handle BOTH IP/OP "$5,201.00 " "$3,848.74" $0.00 "$4,160.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$3,860.18" "$3,860.18" "$4,008.93" $0.00 "$1,083.89" $0.00 $0.00 $0.00 $0.00 "$2,600.50" "$4,119.19" "$4,160.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007885 EAP Custom 27007885 Percutaneous Insertion Handle BOTH IP/OP "$5,201.00 " "$3,848.74" $0.00 "$4,160.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$3,860.18" "$3,860.18" "$4,008.93" $0.00 "$1,083.89" $0.00 $0.00 $0.00 $0.00 "$2,600.50" "$4,119.19" "$4,160.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007887 EAP Custom 27007887 Rec Loc Aim Arm Lat Ent Fem Nl BOTH IP/OP "$4,071.00 " "$3,012.54" $0.00 "$3,256.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$3,021.50" "$3,021.50" "$3,137.93" $0.00 $848.40 $0.00 $0.00 $0.00 $0.00 "$2,035.50" "$3,224.23" "$3,256.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007893 EAP Custom 27007893 Insert Hdle Ti Cann Hum Nls-ex BOTH IP/OP "$4,522.00 " "$3,346.28" $0.00 "$3,617.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$3,356.23" "$3,356.23" "$3,485.56" $0.00 $942.38 $0.00 $0.00 $0.00 $0.00 "$2,261.00" "$3,581.42" "$3,617.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007894 EAP Custom 27007894 Sprl Blde Aim Arm Ti Can Hum N BOTH IP/OP "$4,071.00 " "$3,012.54" $0.00 "$3,256.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$3,021.50" "$3,021.50" "$3,137.93" $0.00 $848.40 $0.00 $0.00 $0.00 $0.00 "$2,035.50" "$3,224.23" "$3,256.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007900 EAP Custom 27007900 12.0mm/8.0mm Protectn Slve 188 BOTH IP/OP $928.00 $686.72 $0.00 $742.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $688.76 $688.76 $715.30 $0.00 $193.40 $0.00 $0.00 $0.00 $0.00 $464.00 $734.98 $742.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007904 EAP Custom 27007904 11.5/8.5 Protectn Slve Rec Lck BOTH IP/OP $635.00 $469.90 $0.00 $508.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $471.30 $471.30 $489.46 $0.00 $132.33 $0.00 $0.00 $0.00 $0.00 $317.50 $502.92 $508.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007909 EAP Custom 27007909 Tap For 6.5mm Recon Screws BOTH IP/OP "$1,997.00 " "$1,477.78" $0.00 "$1,597.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,482.17" "$1,482.17" "$1,539.29" $0.00 $416.17 $0.00 $0.00 $0.00 $0.00 $998.50 "$1,581.62" "$1,597.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007910 EAP Custom 27007910 15.0/13.0 Pro Slve F/spir Bld BOTH IP/OP "$1,616.00 " "$1,195.84" $0.00 "$1,292.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,199.40" "$1,199.40" "$1,245.61" $0.00 $336.77 $0.00 $0.00 $0.00 $0.00 $808.00 "$1,279.87" "$1,292.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007911 EAP Custom 27007911 13.0/3.2 Wre Gde Spir Blde Aim BOTH IP/OP "$1,222.00 " $904.28 $0.00 $977.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $906.97 $906.97 $941.92 $0.00 $254.66 $0.00 $0.00 $0.00 $0.00 $611.00 $967.82 $977.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007912 EAP Custom 27007912 Spir Blde Insert Retrgrde Fem BOTH IP/OP "$3,061.00 " "$2,265.14" $0.00 "$2,448.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,271.87" "$2,271.87" "$2,359.42" $0.00 $637.91 $0.00 $0.00 $0.00 $0.00 "$1,530.50" "$2,424.31" "$2,448.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007913 EAP Custom 27007913 Speclty Lck Meas Dev Ti Fem Nl BOTH IP/OP $616.00 $455.84 $0.00 $492.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $457.20 $457.20 $474.81 $0.00 $128.37 $0.00 $0.00 $0.00 $0.00 $308.00 $487.87 $492.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007914 EAP Custom 27007914 14.0mm/8.0mm Drill Sleeve 130m BOTH IP/OP $679.00 $502.46 $0.00 $543.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $503.95 $503.95 $523.37 $0.00 $141.50 $0.00 $0.00 $0.00 $0.00 $339.50 $537.77 $543.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007919 EAP Custom 27007919 Spir Bld Mea Dev Ti Can Hum Nl BOTH IP/OP "$2,296.00 " "$1,699.04" $0.00 "$1,836.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,704.09" "$1,704.09" "$1,769.76" $0.00 $478.49 $0.00 $0.00 $0.00 $0.00 "$1,148.00" "$1,818.43" "$1,836.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007920 EAP Custom 27007920 Stan Aim Arm Ti Can Hum Nls-ex BOTH IP/OP "$4,071.00 " "$3,012.54" $0.00 "$3,256.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$3,021.50" "$3,021.50" "$3,137.93" $0.00 $848.40 $0.00 $0.00 $0.00 $0.00 "$2,035.50" "$3,224.23" "$3,256.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007921 EAP Custom 27007921 Ream Rod Push Rod Wth Ball Hdl BOTH IP/OP "$1,484.00 " "$1,098.16" $0.00 "$1,187.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,101.42" "$1,101.42" "$1,143.87" $0.00 $309.27 $0.00 $0.00 $0.00 $0.00 $742.00 "$1,175.33" "$1,187.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007932 EAP Custom 27007932 Hold Slve W/ Lcking Device BOTH IP/OP "$3,354.00 " "$2,481.96" $0.00 "$2,683.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,489.34" "$2,489.34" "$2,585.26" $0.00 $698.97 $0.00 $0.00 $0.00 $0.00 "$1,677.00" "$2,656.37" "$2,683.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007935 EAP Custom 27007935 Lrg Hexa Scwdrvr 3.5 Wdth Acrs BOTH IP/OP "$1,199.00 " $887.26 $0.00 $959.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $889.90 $889.90 $924.19 $0.00 $249.87 $0.00 $0.00 $0.00 $0.00 $599.50 $949.61 $959.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007937 EAP Custom 27007937 Shrt Compres Dev Ti Can Tib Nl BOTH IP/OP "$1,799.00 " "$1,331.26" $0.00 "$1,439.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,335.22" "$1,335.22" "$1,386.67" $0.00 $374.91 $0.00 $0.00 $0.00 $0.00 $899.50 "$1,424.81" "$1,439.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007938 EAP Custom 27007938 Lng Compres Dev Ti Can Tib Nl BOTH IP/OP "$1,799.00 " "$1,331.26" $0.00 "$1,439.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,335.22" "$1,335.22" "$1,386.67" $0.00 $374.91 $0.00 $0.00 $0.00 $0.00 $899.50 "$1,424.81" "$1,439.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007941 EAP Custom 27007941 15.0can Flex Dl Bit Lrg Qc/310 BOTH IP/OP "$2,711.00 " "$2,006.14" $0.00 "$2,168.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,012.10" "$2,012.10" "$2,089.64" $0.00 $564.97 $0.00 $0.00 $0.00 $0.00 "$1,355.50" "$2,147.11" "$2,168.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007942 EAP Custom 27007942 17 Can Flex Drl Bit Lrg Qc/310 BOTH IP/OP "$2,711.00 " "$2,006.14" $0.00 "$2,168.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,012.10" "$2,012.10" "$2,089.64" $0.00 $564.97 $0.00 $0.00 $0.00 $0.00 "$1,355.50" "$2,147.11" "$2,168.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007943 EAP Custom 27007943 11/8 Pro Slve 188mm For Asls BOTH IP/OP $889.00 $657.86 $0.00 $711.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $659.82 $659.82 $685.24 $0.00 $185.27 $0.00 $0.00 $0.00 $0.00 $444.50 $704.09 $711.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007945 EAP Custom 27007945 Insert Hndl F/4.5 Lcp Prox Tib BOTH IP/OP "$5,623.00 " "$4,161.02" $0.00 "$4,498.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,173.39" "$4,173.39" "$4,334.21" $0.00 "$1,171.83" $0.00 $0.00 $0.00 $0.00 "$2,811.50" "$4,453.42" "$4,498.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007947 EAP Custom 27007947 Strt Ball Spike Low Pro Pelvic BOTH IP/OP "$1,511.00 " "$1,118.14" $0.00 "$1,208.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,121.46" "$1,121.46" "$1,164.68" $0.00 $314.89 $0.00 $0.00 $0.00 $0.00 $755.50 "$1,196.71" "$1,208.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007948 EAP Custom 27007948 Strt Ball Spike Low Pro Pelvic BOTH IP/OP "$1,608.00 " "$1,189.92" $0.00 "$1,286.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,193.46" "$1,193.46" "$1,239.45" $0.00 $335.11 $0.00 $0.00 $0.00 $0.00 $804.00 "$1,273.54" "$1,286.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007949 EAP Custom 27007949 Strt Reduc Forceps Low Pro Pel BOTH IP/OP "$6,337.00 " "$4,689.38" $0.00 "$5,069.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$4,884.56" $0.00 "$1,320.63" $0.00 $0.00 $0.00 $0.00 "$3,168.50" "$5,018.90" "$5,069.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007952 EAP Custom 27007952 Reduct Forceps For Low Pro Pel BOTH IP/OP "$8,489.00 " "$6,281.86" $0.00 "$6,791.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$6,543.32" $0.00 "$1,769.11" $0.00 $0.00 $0.00 $0.00 "$4,244.50" "$6,723.29" "$6,791.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007954 EAP Custom 27007954 Lo Pro Pel Sys Rd Frcp 3.5 Scw BOTH IP/OP "$7,620.00 " "$5,638.80" $0.00 "$6,096.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,873.50" $0.00 "$1,588.01" $0.00 $0.00 $0.00 $0.00 "$3,810.00" "$6,035.04" "$6,096.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007955 EAP Custom 27007955 Round Disk BOTH IP/OP $812.00 $600.88 $0.00 $649.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $602.67 $602.67 $625.89 $0.00 $169.22 $0.00 $0.00 $0.00 $0.00 $406.00 $643.10 $649.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007956 EAP Custom 27007956 Rectangular Disk BOTH IP/OP $812.00 $600.88 $0.00 $649.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $602.67 $602.67 $625.89 $0.00 $169.22 $0.00 $0.00 $0.00 $0.00 $406.00 $643.10 $649.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007966 EAP Custom 27007966 Instn Hndl F/4.5 Lcp Prox Tib BOTH IP/OP "$5,623.00 " "$4,161.02" $0.00 "$4,498.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,173.39" "$4,173.39" "$4,334.21" $0.00 "$1,171.83" $0.00 $0.00 $0.00 $0.00 "$2,811.50" "$4,453.42" "$4,498.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007967 EAP Custom 27007967 Solid 4.0 Hex Scwdrvr Shft 200 BOTH IP/OP "$1,131.00 " $836.94 $0.00 $904.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $839.43 $839.43 $871.77 $0.00 $235.70 $0.00 $0.00 $0.00 $0.00 $565.50 $895.75 $904.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007969 EAP Custom 27007969 Spiked Round Disk BOTH IP/OP "$1,247.00 " $922.78 $0.00 $997.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $925.52 $925.52 $961.19 $0.00 $259.87 $0.00 $0.00 $0.00 $0.00 $623.50 $987.62 $997.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007970 EAP Custom 27007970 Spiked Rectangular Disk BOTH IP/OP "$1,247.00 " $922.78 $0.00 $997.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $925.52 $925.52 $961.19 $0.00 $259.87 $0.00 $0.00 $0.00 $0.00 $623.50 $987.62 $997.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007974 EAP Custom 27007974 Ped Lcp Hip Pl Gdng Blk 3.5scw BOTH IP/OP "$1,986.00 " "$1,469.64" $0.00 "$1,588.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,474.01" "$1,474.01" "$1,530.81" $0.00 $413.88 $0.00 $0.00 $0.00 $0.00 $993.00 "$1,572.91" "$1,588.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007975 EAP Custom 27007975 Ped Lcp Hip Pl Gdng Blck 5scw BOTH IP/OP "$1,986.00 " "$1,469.64" $0.00 "$1,588.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,474.01" "$1,474.01" "$1,530.81" $0.00 $413.88 $0.00 $0.00 $0.00 $0.00 $993.00 "$1,572.91" "$1,588.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007977 EAP Custom 27007977 Reduction Sleeve 4.3mm/2.8mm BOTH IP/OP $647.00 $478.78 $0.00 $517.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $480.20 $480.20 $498.71 $0.00 $134.83 $0.00 $0.00 $0.00 $0.00 $323.50 $512.42 $517.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007979 EAP Custom 27007979 Positioning Device Gdng Blck BOTH IP/OP "$1,727.00 " "$1,277.98" $0.00 "$1,381.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,281.78" "$1,281.78" "$1,331.17" $0.00 $359.91 $0.00 $0.00 $0.00 $0.00 $863.50 "$1,367.78" "$1,381.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007980 EAP Custom 27007980 Medialization Gde 3.5&5.0 Lcp BOTH IP/OP "$1,727.00 " "$1,277.98" $0.00 "$1,381.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,281.78" "$1,281.78" "$1,331.17" $0.00 $359.91 $0.00 $0.00 $0.00 $0.00 $863.50 "$1,367.78" "$1,381.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007981 EAP Custom 27007981 Osteotomy Measuring Device BOTH IP/OP "$1,061.00 " $785.14 $0.00 $848.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $787.47 $787.47 $817.82 $0.00 $221.11 $0.00 $0.00 $0.00 $0.00 $530.50 $840.31 $848.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007984 EAP Custom 27007984 Meas Dev 3.0 Hdles Compres Scw BOTH IP/OP $722.00 $534.28 $0.00 $577.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $535.87 $535.87 $556.52 $0.00 $150.46 $0.00 $0.00 $0.00 $0.00 $361.00 $571.82 $577.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007990 EAP Custom 27007990 Meas Dev F/drl Gde W/stp 3.0m BOTH IP/OP $642.00 $475.08 $0.00 $513.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $476.49 $476.49 $494.85 $0.00 $133.79 $0.00 $0.00 $0.00 $0.00 $321.00 $508.46 $513.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007991 EAP Custom 27007991 Medium Open Compressor BOTH IP/OP "$4,431.00 " "$3,278.94" $0.00 "$3,544.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$3,288.69" "$3,288.69" "$3,415.41" $0.00 $923.42 $0.00 $0.00 $0.00 $0.00 "$2,215.50" "$3,509.35" "$3,544.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007992 EAP Custom 27007992 Lo-pro Wrst Fxtr/schan Scr/200 BOTH IP/OP "$4,535.00 " "$3,355.90" $0.00 "$3,628.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$3,365.88" "$3,365.88" "$3,495.58" $0.00 $945.09 $0.00 $0.00 $0.00 $0.00 "$2,267.50" "$3,591.72" "$3,628.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007993 EAP Custom 27007993 Lo-pro Wrst Fxtr/schan Scr/220 BOTH IP/OP "$4,535.00 " "$3,355.90" $0.00 "$3,628.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$3,365.88" "$3,365.88" "$3,495.58" $0.00 $945.09 $0.00 $0.00 $0.00 $0.00 "$2,267.50" "$3,591.72" "$3,628.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007994 EAP Custom 27007994 Low-pro Wrst Fxtr/slf-drlg/200 BOTH IP/OP "$5,757.00 " "$4,260.18" $0.00 "$4,605.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$4,437.50" $0.00 "$1,199.76" $0.00 $0.00 $0.00 $0.00 "$2,878.50" "$4,559.54" "$4,605.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007995 EAP Custom 27007995 Low-pro Wrst Fxtr/slf-drlg/220 BOTH IP/OP "$5,757.00 " "$4,260.18" $0.00 "$4,605.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$4,437.50" $0.00 "$1,199.76" $0.00 $0.00 $0.00 $0.00 "$2,878.50" "$4,559.54" "$4,605.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007996 EAP Custom 27007996 Tensioner BOTH IP/OP "$16,191.00 " "$11,981.34" $0.00 "$12,952.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$12,480.02" $0.00 "$3,374.20" $0.00 $0.00 $0.00 $0.00 "$8,095.50" "$12,823.27" "$12,952.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007997 EAP Custom 27007997 Slotted Socket Wrench 11mm BOTH IP/OP "$2,314.00 " "$1,712.36" $0.00 "$1,851.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,717.45" "$1,717.45" "$1,783.63" $0.00 $482.24 $0.00 $0.00 $0.00 $0.00 "$1,157.00" "$1,832.69" "$1,851.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007998 EAP Custom 27007998 Patient Wrench 8mm/11mm BOTH IP/OP $604.00 $446.96 $0.00 $483.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $448.29 $448.29 $465.56 $0.00 $125.87 $0.00 $0.00 $0.00 $0.00 $302.00 $478.37 $483.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27007999 EAP Custom 27007999 Ratchet Wrench 11mm BOTH IP/OP "$2,891.00 " "$2,139.34" $0.00 "$2,312.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,145.70" "$2,145.70" "$2,228.38" $0.00 $602.48 $0.00 $0.00 $0.00 $0.00 "$1,445.50" "$2,289.67" "$2,312.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008000 EAP Custom 27008000 Split Tissue Protect Slve 2.5m BOTH IP/OP "$2,314.00 " "$1,712.36" $0.00 "$1,851.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,717.45" "$1,717.45" "$1,783.63" $0.00 $482.24 $0.00 $0.00 $0.00 $0.00 "$1,157.00" "$1,832.69" "$1,851.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008001 EAP Custom 27008001 Split Tissue Protect Slve 5mm BOTH IP/OP "$2,314.00 " "$1,712.36" $0.00 "$1,851.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,717.45" "$1,717.45" "$1,783.63" $0.00 $482.24 $0.00 $0.00 $0.00 $0.00 "$1,157.00" "$1,832.69" "$1,851.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008004 EAP Custom 27008004 Schanz Screw Bolt Mr Safe BOTH IP/OP $906.00 $670.44 $0.00 $724.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $672.43 $672.43 $698.34 $0.00 $188.81 $0.00 $0.00 $0.00 $0.00 $453.00 $717.55 $724.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008005 EAP Custom 27008005 Pivot Schanz Screw Clamp Mr Sa BOTH IP/OP "$1,830.00 " "$1,354.20" $0.00 "$1,464.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,358.23" "$1,358.23" "$1,410.56" $0.00 $381.37 $0.00 $0.00 $0.00 $0.00 $915.00 "$1,449.36" "$1,464.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008006 EAP Custom 27008006 Locking Hinge Mr Safe BOTH IP/OP $906.00 $670.44 $0.00 $724.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $672.43 $672.43 $698.34 $0.00 $188.81 $0.00 $0.00 $0.00 $0.00 $453.00 $717.55 $724.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008007 EAP Custom 27008007 Schanz Screw Bolt Post Mount M BOTH IP/OP "$1,045.00 " $773.30 $0.00 $836.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $775.60 $775.60 $805.49 $0.00 $217.78 $0.00 $0.00 $0.00 $0.00 $522.50 $827.64 $836.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008008 EAP Custom 27008008 Smth Wire/1.5mm Diameter 400m BOTH IP/OP $308.00 $227.92 $0.00 $246.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $228.60 $228.60 $237.41 $0.00 $64.19 $0.00 $0.00 $0.00 $0.00 $154.00 $243.94 $246.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008009 EAP Custom 27008009 Smth Wire/1.8mm Diameter 400m BOTH IP/OP $308.00 $227.92 $0.00 $246.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $228.60 $228.60 $237.41 $0.00 $64.19 $0.00 $0.00 $0.00 $0.00 $154.00 $243.94 $246.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008010 EAP Custom 27008010 Smth Wire/2.0mm Diameter 400m BOTH IP/OP $308.00 $227.92 $0.00 $246.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $228.60 $228.60 $237.41 $0.00 $64.19 $0.00 $0.00 $0.00 $0.00 $154.00 $243.94 $246.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008011 EAP Custom 27008011 Smth Wire 1.5m Dia Hlf Pnt Tip BOTH IP/OP $308.00 $227.92 $0.00 $246.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $228.60 $228.60 $237.41 $0.00 $64.19 $0.00 $0.00 $0.00 $0.00 $154.00 $243.94 $246.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008012 EAP Custom 27008012 Smth Wire 1.8m Dia Hlf Pnt Tip BOTH IP/OP $308.00 $227.92 $0.00 $246.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $228.60 $228.60 $237.41 $0.00 $64.19 $0.00 $0.00 $0.00 $0.00 $154.00 $243.94 $246.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008013 EAP Custom 27008013 Smth Wire 2.0m Dia Hlf Pnt Tip BOTH IP/OP $308.00 $227.92 $0.00 $246.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $228.60 $228.60 $237.41 $0.00 $64.19 $0.00 $0.00 $0.00 $0.00 $154.00 $243.94 $246.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008014 EAP Custom 27008014 Reductn Wre/1.5mm Diam 400m BOTH IP/OP $962.00 $711.88 $0.00 $769.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $714.00 $714.00 $741.51 $0.00 $200.48 $0.00 $0.00 $0.00 $0.00 $481.00 $761.90 $769.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008015 EAP Custom 27008015 Reductn Wre/1.8mm Diam 400m BOTH IP/OP $962.00 $711.88 $0.00 $769.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $714.00 $714.00 $741.51 $0.00 $200.48 $0.00 $0.00 $0.00 $0.00 $481.00 $761.90 $769.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008016 EAP Custom 27008016 Reductn Wire/2.0mm Diam 400m BOTH IP/OP $962.00 $711.88 $0.00 $769.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $714.00 $714.00 $741.51 $0.00 $200.48 $0.00 $0.00 $0.00 $0.00 $481.00 $761.90 $769.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008017 EAP Custom 27008017 Reductn Wre 1.5mm Dia Half Pnt BOTH IP/OP $962.00 $711.88 $0.00 $769.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $714.00 $714.00 $741.51 $0.00 $200.48 $0.00 $0.00 $0.00 $0.00 $481.00 $761.90 $769.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008018 EAP Custom 27008018 Reductn Wre 1.8mm Dia Hlf Pnt BOTH IP/OP $962.00 $711.88 $0.00 $769.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $714.00 $714.00 $741.51 $0.00 $200.48 $0.00 $0.00 $0.00 $0.00 $481.00 $761.90 $769.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008019 EAP Custom 27008019 Reductn Wre 2.0mm Dia Half Pnt BOTH IP/OP $962.00 $711.88 $0.00 $769.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $714.00 $714.00 $741.51 $0.00 $200.48 $0.00 $0.00 $0.00 $0.00 $481.00 $761.90 $769.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008020 EAP Custom 27008020 Wire Bolt/slotted Mr Safe BOTH IP/OP $197.00 $145.78 $0.00 $157.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $146.21 $146.21 $151.85 $0.00 $41.05 $0.00 $0.00 $0.00 $0.00 $98.50 $156.02 $157.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008021 EAP Custom 27008021 Wire Bolt/offset Mr Safe BOTH IP/OP $183.00 $135.42 $0.00 $146.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $135.82 $135.82 $141.06 $0.00 $38.14 $0.00 $0.00 $0.00 $0.00 $91.50 $144.94 $146.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008024 EAP Custom 27008024 Schanz Scrw Bolt Can Rng Mnt BOTH IP/OP $906.00 $670.44 $0.00 $724.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $672.43 $672.43 $698.34 $0.00 $188.81 $0.00 $0.00 $0.00 $0.00 $453.00 $717.55 $724.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008025 EAP Custom 27008025 Schanz Scrw Bolt Can Post Mnt BOTH IP/OP "$1,045.00 " $773.30 $0.00 $836.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $775.60 $775.60 $805.49 $0.00 $217.78 $0.00 $0.00 $0.00 $0.00 $522.50 $827.64 $836.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008026 EAP Custom 27008026 Square Nut Mr Safe BOTH IP/OP $337.00 $249.38 $0.00 $269.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $250.12 $250.12 $259.76 $0.00 $70.23 $0.00 $0.00 $0.00 $0.00 $168.50 $266.90 $269.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008027 EAP Custom 27008027 Nut Mr Safe BOTH IP/OP $16.00 $11.84 $0.00 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.88 $11.88 $12.33 $0.00 $3.33 $0.00 $0.00 $0.00 $0.00 $8.00 $12.67 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008028 EAP Custom 27008028 Nut 10 Pack Mr Safe BOTH IP/OP $154.00 $113.96 $0.00 $123.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $114.30 $114.30 $118.70 $0.00 $32.09 $0.00 $0.00 $0.00 $0.00 $77.00 $121.97 $123.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008029 EAP Custom 27008029 Speed Nut Mr Safe BOTH IP/OP $652.00 $482.48 $0.00 $521.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $483.91 $483.91 $502.56 $0.00 $135.88 $0.00 $0.00 $0.00 $0.00 $326.00 $516.38 $521.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008030 EAP Custom 27008030 Wire Post-short Mr Safe BOTH IP/OP $812.00 $600.88 $0.00 $649.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $602.67 $602.67 $625.89 $0.00 $169.22 $0.00 $0.00 $0.00 $0.00 $406.00 $643.10 $649.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008031 EAP Custom 27008031 Wire Post-tall Mr Safe BOTH IP/OP $928.00 $686.72 $0.00 $742.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $688.76 $688.76 $715.30 $0.00 $193.40 $0.00 $0.00 $0.00 $0.00 $464.00 $734.98 $742.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008032 EAP Custom 27008032 Spacing Washer 1mm Mr Safe BOTH IP/OP $16.00 $11.84 $0.00 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.88 $11.88 $12.33 $0.00 $3.33 $0.00 $0.00 $0.00 $0.00 $8.00 $12.67 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008033 EAP Custom 27008033 Spacing Washer 2mm Mr Safe BOTH IP/OP $21.00 $15.54 $0.00 $16.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $15.59 $15.59 $16.19 $0.00 $4.38 $0.00 $0.00 $0.00 $0.00 $10.50 $16.63 $16.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008034 EAP Custom 27008034 Spacing Washer 4mm Mr Safe BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008035 EAP Custom 27008035 Spherical Washer Couple Mr Saf BOTH IP/OP $145.00 $107.30 $0.00 $116.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $107.62 $107.62 $111.77 $0.00 $30.22 $0.00 $0.00 $0.00 $0.00 $72.50 $114.84 $116.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008036 EAP Custom 27008036 Oblique Support Mr Safe BOTH IP/OP "$2,314.00 " "$1,712.36" $0.00 "$1,851.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,717.45" "$1,717.45" "$1,783.63" $0.00 $482.24 $0.00 $0.00 $0.00 $0.00 "$1,157.00" "$1,832.69" "$1,851.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008038 EAP Custom 27008038 Thread Rod 80 Lng/slot Mr Safe BOTH IP/OP $280.00 $207.20 $0.00 $224.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $207.82 $207.82 $215.82 $0.00 $58.35 $0.00 $0.00 $0.00 $0.00 $140.00 $221.76 $224.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008039 EAP Custom 27008039 Thread Rod 100 Lng/slot Mr Sfe BOTH IP/OP $280.00 $207.20 $0.00 $224.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $207.82 $207.82 $215.82 $0.00 $58.35 $0.00 $0.00 $0.00 $0.00 $140.00 $221.76 $224.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008040 EAP Custom 27008040 Threaded Rod 120mm Lng Mr Safe BOTH IP/OP $280.00 $207.20 $0.00 $224.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $207.82 $207.82 $215.82 $0.00 $58.35 $0.00 $0.00 $0.00 $0.00 $140.00 $221.76 $224.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008041 EAP Custom 27008041 Threaded Rod 150mm Lng Mr Safe BOTH IP/OP $280.00 $207.20 $0.00 $224.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $207.82 $207.82 $215.82 $0.00 $58.35 $0.00 $0.00 $0.00 $0.00 $140.00 $221.76 $224.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008042 EAP Custom 27008042 Threaded Rod 200mm Lng Mr Safe BOTH IP/OP $301.00 $222.74 $0.00 $240.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $223.40 $223.40 $232.01 $0.00 $62.73 $0.00 $0.00 $0.00 $0.00 $150.50 $238.39 $240.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008043 EAP Custom 27008043 Threaded Rod 250mm Lng Mr Safe BOTH IP/OP $301.00 $222.74 $0.00 $240.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $223.40 $223.40 $232.01 $0.00 $62.73 $0.00 $0.00 $0.00 $0.00 $150.50 $238.39 $240.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008044 EAP Custom 27008044 Threaded Rod 300mm Lng Mr Safe BOTH IP/OP $347.00 $256.78 $0.00 $277.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $257.54 $257.54 $267.47 $0.00 $72.31 $0.00 $0.00 $0.00 $0.00 $173.50 $274.82 $277.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008045 EAP Custom 27008045 Threaded Rod 350mm Lng Mr Safe BOTH IP/OP $347.00 $256.78 $0.00 $277.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $257.54 $257.54 $267.47 $0.00 $72.31 $0.00 $0.00 $0.00 $0.00 $173.50 $274.82 $277.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008046 EAP Custom 27008046 Threaded Rod 400mm Lng Mr Safe BOTH IP/OP $441.00 $326.34 $0.00 $352.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $327.31 $327.31 $339.92 $0.00 $91.90 $0.00 $0.00 $0.00 $0.00 $220.50 $349.27 $352.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008051 EAP Custom 27008051 Standoff 20mm Long Mr Safe BOTH IP/OP $185.00 $136.90 $0.00 $148.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $137.31 $137.31 $142.60 $0.00 $38.55 $0.00 $0.00 $0.00 $0.00 $92.50 $146.52 $148.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008052 EAP Custom 27008052 Standoff 30mm Long Mr Safe BOTH IP/OP $208.00 $153.92 $0.00 $166.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $154.38 $154.38 $160.33 $0.00 $43.35 $0.00 $0.00 $0.00 $0.00 $104.00 $164.74 $166.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008053 EAP Custom 27008053 Standoff 40mm Long Mr Safe BOTH IP/OP $234.00 $173.16 $0.00 $187.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $173.67 $173.67 $180.37 $0.00 $48.77 $0.00 $0.00 $0.00 $0.00 $117.00 $185.33 $187.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008054 EAP Custom 27008054 Standoff 50mm Long Mr Safe BOTH IP/OP $301.00 $222.74 $0.00 $240.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $223.40 $223.40 $232.01 $0.00 $62.73 $0.00 $0.00 $0.00 $0.00 $150.50 $238.39 $240.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008055 EAP Custom 27008055 Ti Half Ring/80m Diam Mr Safe BOTH IP/OP "$1,505.00 " "$1,113.70" $0.00 "$1,204.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,117.01" "$1,117.01" "$1,160.05" $0.00 $313.64 $0.00 $0.00 $0.00 $0.00 $752.50 "$1,191.96" "$1,204.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008056 EAP Custom 27008056 Ti Half Ring/100m Diam Mr Safe BOTH IP/OP "$1,624.00 " "$1,201.76" $0.00 "$1,299.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,205.33" "$1,205.33" "$1,251.78" $0.00 $338.44 $0.00 $0.00 $0.00 $0.00 $812.00 "$1,286.21" "$1,299.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008057 EAP Custom 27008057 Ti Half Ring/110m Diam Mr Safe BOTH IP/OP "$1,667.00 " "$1,233.58" $0.00 "$1,333.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,237.25" "$1,237.25" "$1,284.92" $0.00 $347.40 $0.00 $0.00 $0.00 $0.00 $833.50 "$1,320.26" "$1,333.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008058 EAP Custom 27008058 Ti Half Ring/120m Diam Mr Safe BOTH IP/OP "$1,735.00 " "$1,283.90" $0.00 "$1,388.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,287.72" "$1,287.72" "$1,337.34" $0.00 $361.57 $0.00 $0.00 $0.00 $0.00 $867.50 "$1,374.12" "$1,388.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008059 EAP Custom 27008059 Ti Half Ring/130m Diam Mr Safe BOTH IP/OP "$1,783.00 " "$1,319.42" $0.00 "$1,426.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,323.34" "$1,323.34" "$1,374.34" $0.00 $371.58 $0.00 $0.00 $0.00 $0.00 $891.50 "$1,412.14" "$1,426.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008060 EAP Custom 27008060 Ti Half Ring/140m Diam Mr Safe BOTH IP/OP "$1,850.00 " "$1,369.00" $0.00 "$1,480.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,373.07" "$1,373.07" "$1,425.98" $0.00 $385.54 $0.00 $0.00 $0.00 $0.00 $925.00 "$1,465.20" "$1,480.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008061 EAP Custom 27008061 Ti Half Ring/150m Diam Mr Safe BOTH IP/OP "$1,969.00 " "$1,457.06" $0.00 "$1,575.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,461.39" "$1,461.39" "$1,517.71" $0.00 $410.34 $0.00 $0.00 $0.00 $0.00 $984.50 "$1,559.45" "$1,575.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008062 EAP Custom 27008062 Ti Half Ring/160m Diam Mr Safe BOTH IP/OP "$2,153.00 " "$1,593.22" $0.00 "$1,722.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,597.96" "$1,597.96" "$1,659.53" $0.00 $448.69 $0.00 $0.00 $0.00 $0.00 "$1,076.50" "$1,705.18" "$1,722.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008063 EAP Custom 27008063 Ti Half Ring/180m Diam Mr Safe BOTH IP/OP "$2,314.00 " "$1,712.36" $0.00 "$1,851.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,717.45" "$1,717.45" "$1,783.63" $0.00 $482.24 $0.00 $0.00 $0.00 $0.00 "$1,157.00" "$1,832.69" "$1,851.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008064 EAP Custom 27008064 Ti Half Ring/200m Diam Mr Safe BOTH IP/OP "$2,498.00 " "$1,848.52" $0.00 "$1,998.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,854.02" "$1,854.02" "$1,925.46" $0.00 $520.58 $0.00 $0.00 $0.00 $0.00 "$1,249.00" "$1,978.42" "$1,998.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008065 EAP Custom 27008065 Ti Half Ring/220m Diam Mr Safe BOTH IP/OP "$2,663.00 " "$1,970.62" $0.00 "$2,130.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,976.48" "$1,976.48" "$2,052.64" $0.00 $554.97 $0.00 $0.00 $0.00 $0.00 "$1,331.50" "$2,109.10" "$2,130.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008066 EAP Custom 27008066 Ti Half Ring/240m Diam Mr Safe BOTH IP/OP "$2,779.00 " "$2,056.46" $0.00 "$2,223.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,062.57" "$2,062.57" "$2,142.05" $0.00 $579.14 $0.00 $0.00 $0.00 $0.00 "$1,389.50" "$2,200.97" "$2,223.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008067 EAP Custom 27008067 Ti Full Ring/140m Diam Mr Safe BOTH IP/OP "$3,704.00 " "$2,740.96" $0.00 "$2,963.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,749.11" "$2,749.11" "$2,855.04" $0.00 $771.91 $0.00 $0.00 $0.00 $0.00 "$1,852.00" "$2,933.57" "$2,963.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008068 EAP Custom 27008068 Ti Full Ring/160m Diam Mr Safe BOTH IP/OP "$4,303.00 " "$3,184.22" $0.00 "$3,442.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$3,193.69" "$3,193.69" "$3,316.75" $0.00 $896.75 $0.00 $0.00 $0.00 $0.00 "$2,151.50" "$3,407.98" "$3,442.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008069 EAP Custom 27008069 Ti Full Ring/180m Diam Mr Safe BOTH IP/OP "$4,627.00 " "$3,423.98" $0.00 "$3,701.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$3,434.16" "$3,434.16" "$3,566.49" $0.00 $964.27 $0.00 $0.00 $0.00 $0.00 "$2,313.50" "$3,664.58" "$3,701.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008070 EAP Custom 27008070 Ti Full Ring/200m Diam Mr Safe BOTH IP/OP "$5,022.00 " "$3,716.28" $0.00 "$4,017.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$3,727.33" "$3,727.33" "$3,870.96" $0.00 "$1,046.58" $0.00 $0.00 $0.00 $0.00 "$2,511.00" "$3,977.42" "$4,017.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008071 EAP Custom 27008071 Ti 5/8 Ring/130m Diam Mr Safe BOTH IP/OP "$2,430.00 " "$1,798.20" $0.00 "$1,944.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,803.55" "$1,803.55" "$1,873.04" $0.00 $506.41 $0.00 $0.00 $0.00 $0.00 "$1,215.00" "$1,924.56" "$1,944.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008072 EAP Custom 27008072 Ti 5/8 Ring/150mm Diam Mr Safe BOTH IP/OP "$2,663.00 " "$1,970.62" $0.00 "$2,130.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,976.48" "$1,976.48" "$2,052.64" $0.00 $554.97 $0.00 $0.00 $0.00 $0.00 "$1,331.50" "$2,109.10" "$2,130.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008073 EAP Custom 27008073 Ti 5/8 Ring/160mm Diam Mr Safe BOTH IP/OP "$2,891.00 " "$2,139.34" $0.00 "$2,312.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,145.70" "$2,145.70" "$2,228.38" $0.00 $602.48 $0.00 $0.00 $0.00 $0.00 "$1,445.50" "$2,289.67" "$2,312.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008074 EAP Custom 27008074 Ti 5/8 Ring/180mm Diam Mr Safe BOTH IP/OP "$3,358.00 " "$2,484.92" $0.00 "$2,686.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,492.31" "$2,492.31" "$2,588.35" $0.00 $699.81 $0.00 $0.00 $0.00 $0.00 "$1,679.00" "$2,659.54" "$2,686.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008075 EAP Custom 27008075 Ti 5/8 Ring/200mm Diam Mr Safe BOTH IP/OP "$3,470.00 " "$2,567.80" $0.00 "$2,776.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,575.43" "$2,575.43" "$2,674.68" $0.00 $723.15 $0.00 $0.00 $0.00 $0.00 "$1,735.00" "$2,748.24" "$2,776.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008076 EAP Custom 27008076 Ti Fem Arch Pl 180 Dia/90 Degr BOTH IP/OP "$4,165.00 " "$3,082.10" $0.00 "$3,332.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$3,091.26" "$3,091.26" "$3,210.38" $0.00 $867.99 $0.00 $0.00 $0.00 $0.00 "$2,082.50" "$3,298.68" "$3,332.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008077 EAP Custom 27008077 Ti Fem Arch Pl 180 Dia/120 Deg BOTH IP/OP "$4,281.00 " "$3,167.94" $0.00 "$3,424.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$3,177.36" "$3,177.36" "$3,299.79" $0.00 $892.16 $0.00 $0.00 $0.00 $0.00 "$2,140.50" "$3,390.55" "$3,424.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008078 EAP Custom 27008078 Ti Fem Arch Pl 240 Dia/90 Degr BOTH IP/OP "$4,515.00 " "$3,341.10" $0.00 "$3,612.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$3,351.03" "$3,351.03" "$3,480.16" $0.00 $940.93 $0.00 $0.00 $0.00 $0.00 "$2,257.50" "$3,575.88" "$3,612.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008079 EAP Custom 27008079 Ti Fem Arch Pl 240 Dia/120 Deg BOTH IP/OP "$4,627.00 " "$3,423.98" $0.00 "$3,701.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$3,434.16" "$3,434.16" "$3,566.49" $0.00 $964.27 $0.00 $0.00 $0.00 $0.00 "$2,313.50" "$3,664.58" "$3,701.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008080 EAP Custom 27008080 Linear Distrac 60 Lng 25mm Tr BOTH IP/OP "$2,663.00 " "$1,970.62" $0.00 "$2,130.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,976.48" "$1,976.48" "$2,052.64" $0.00 $554.97 $0.00 $0.00 $0.00 $0.00 "$1,331.50" "$2,109.10" "$2,130.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008081 EAP Custom 27008081 Linear Distrac 120lng 85mm Tra BOTH IP/OP "$2,891.00 " "$2,139.34" $0.00 "$2,312.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,145.70" "$2,145.70" "$2,228.38" $0.00 $602.48 $0.00 $0.00 $0.00 $0.00 "$1,445.50" "$2,289.67" "$2,312.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008082 EAP Custom 27008082 Linear Distrac 180 Lng 145 Tra BOTH IP/OP "$3,241.00 " "$2,398.34" $0.00 "$2,592.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,405.47" "$2,405.47" "$2,498.16" $0.00 $675.42 $0.00 $0.00 $0.00 $0.00 "$1,620.50" "$2,566.87" "$2,592.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008083 EAP Custom 27008083 Linear Distrac 250 Lng 215 Tra BOTH IP/OP "$3,934.00 " "$2,911.16" $0.00 "$3,147.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,919.81" "$2,919.81" "$3,032.33" $0.00 $819.85 $0.00 $0.00 $0.00 $0.00 "$1,967.00" "$3,115.73" "$3,147.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008118 EAP Custom 27008118 Sft Tissue Sprder Trocar 35mm BOTH IP/OP "$1,247.00 " $922.78 $0.00 $997.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $925.52 $925.52 $961.19 $0.00 $259.87 $0.00 $0.00 $0.00 $0.00 $623.50 $987.62 $997.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008119 EAP Custom 27008119 Sft Tissue Sprder Trocar 75 BOTH IP/OP "$1,247.00 " $922.78 $0.00 $997.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $925.52 $925.52 $961.19 $0.00 $259.87 $0.00 $0.00 $0.00 $0.00 $623.50 $987.62 $997.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008122 EAP Custom 27008122 Straight Sharp Hook BOTH IP/OP $600.00 $444.00 $0.00 $480.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $445.32 $445.32 $462.48 $0.00 $125.04 $0.00 $0.00 $0.00 $0.00 $300.00 $475.20 $480.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008124 EAP Custom 27008124 Small Screw Removal Forceps BOTH IP/OP "$1,770.00 " "$1,309.80" $0.00 "$1,416.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,313.69" "$1,313.69" "$1,364.32" $0.00 $368.87 $0.00 $0.00 $0.00 $0.00 $885.00 "$1,401.84" "$1,416.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008125 EAP Custom 27008125 Large Screw Removal Forceps BOTH IP/OP "$2,123.00 " "$1,571.02" $0.00 "$1,698.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,575.69" "$1,575.69" "$1,636.41" $0.00 $442.43 $0.00 $0.00 $0.00 $0.00 "$1,061.50" "$1,681.42" "$1,698.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008126 EAP Custom 27008126 Ti End Cap T25 Strdr 0mext Hu BOTH IP/OP $631.00 $466.94 $0.00 $504.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $468.33 $468.33 $486.37 $0.00 $131.50 $0.00 $0.00 $0.00 $0.00 $315.50 $499.75 $504.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008127 EAP Custom 27008127 Ti End Cap T25 Strdrv 0mm Ext BOTH IP/OP $759.00 $561.66 $0.00 $607.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $563.33 $563.33 $585.04 $0.00 $158.18 $0.00 $0.00 $0.00 $0.00 $379.50 $601.13 $607.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008128 EAP Custom 27008128 Ti End Cap T25 Strdrv 5mm Ext BOTH IP/OP $631.00 $466.94 $0.00 $504.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $468.33 $468.33 $486.37 $0.00 $131.50 $0.00 $0.00 $0.00 $0.00 $315.50 $499.75 $504.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008129 EAP Custom 27008129 Ti End Cap T25 Strdrv 5mm Ext BOTH IP/OP $759.00 $561.66 $0.00 $607.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $563.33 $563.33 $585.04 $0.00 $158.18 $0.00 $0.00 $0.00 $0.00 $379.50 $601.13 $607.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008130 EAP Custom 27008130 Ti End Cap T25 Strdrv 10mm Ex BOTH IP/OP $631.00 $466.94 $0.00 $504.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $468.33 $468.33 $486.37 $0.00 $131.50 $0.00 $0.00 $0.00 $0.00 $315.50 $499.75 $504.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008131 EAP Custom 27008131 Ti End Cap T25 Strdrv 10mm Ex BOTH IP/OP $759.00 $561.66 $0.00 $607.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $563.33 $563.33 $585.04 $0.00 $158.18 $0.00 $0.00 $0.00 $0.00 $379.50 $601.13 $607.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008132 EAP Custom 27008132 Ti End Cap T25 Strdrv 15mm Ext BOTH IP/OP $631.00 $466.94 $0.00 $504.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $468.33 $468.33 $486.37 $0.00 $131.50 $0.00 $0.00 $0.00 $0.00 $315.50 $499.75 $504.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008133 EAP Custom 27008133 Ti End Cap T25 Strdrv 15mm Ex BOTH IP/OP $759.00 $561.66 $0.00 $607.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $563.33 $563.33 $585.04 $0.00 $158.18 $0.00 $0.00 $0.00 $0.00 $379.50 $601.13 $607.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008138 EAP Custom 27008138 11m Ti Can Prox Hum Nl-ex/150m BOTH IP/OP "$7,722.00 " "$5,714.28" $0.00 "$6,177.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,952.12" $0.00 "$1,609.26" $0.00 $0.00 $0.00 $0.00 "$3,861.00" "$6,115.82" "$6,177.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008139 EAP Custom 27008139 11m Ti Can Hum Nail-ex/190-320 BOTH IP/OP "$7,722.00 " "$5,714.28" $0.00 "$6,177.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,952.12" $0.00 "$1,609.26" $0.00 $0.00 $0.00 $0.00 "$3,861.00" "$6,115.82" "$6,177.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008140 EAP Custom 27008140 Ti End Cap T40 Sdrv 0mext Fem BOTH IP/OP $682.00 $504.68 $0.00 $545.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $506.18 $506.18 $525.69 $0.00 $142.13 $0.00 $0.00 $0.00 $0.00 $341.00 $540.14 $545.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008141 EAP Custom 27008141 Ti End Cap T40 Sdrv 0mext Ste BOTH IP/OP $812.00 $600.88 $0.00 $649.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $602.67 $602.67 $625.89 $0.00 $169.22 $0.00 $0.00 $0.00 $0.00 $406.00 $643.10 $649.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008142 EAP Custom 27008142 12 Ti End Cap T40 Sdrv 5m Ext BOTH IP/OP $682.00 $504.68 $0.00 $545.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $506.18 $506.18 $525.69 $0.00 $142.13 $0.00 $0.00 $0.00 $0.00 $341.00 $540.14 $545.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008143 EAP Custom 27008143 12 Ti End Cap T40 Sdrv 5m Ext BOTH IP/OP $812.00 $600.88 $0.00 $649.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $602.67 $602.67 $625.89 $0.00 $169.22 $0.00 $0.00 $0.00 $0.00 $406.00 $643.10 $649.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008144 EAP Custom 27008144 12 Ti End Cap T40 Sdrv 10mm Ex BOTH IP/OP $682.00 $504.68 $0.00 $545.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $506.18 $506.18 $525.69 $0.00 $142.13 $0.00 $0.00 $0.00 $0.00 $341.00 $540.14 $545.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008145 EAP Custom 27008145 12 Ti End Cap T40 Sdrv 10mm Ex BOTH IP/OP $812.00 $600.88 $0.00 $649.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $602.67 $602.67 $625.89 $0.00 $169.22 $0.00 $0.00 $0.00 $0.00 $406.00 $643.10 $649.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008146 EAP Custom 27008146 12 Ti End Cap T40 Sdrv 15mm Ex BOTH IP/OP $682.00 $504.68 $0.00 $545.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $506.18 $506.18 $525.69 $0.00 $142.13 $0.00 $0.00 $0.00 $0.00 $341.00 $540.14 $545.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008147 EAP Custom 27008147 12 Ti End Cap T40 Sdrv 15mm Ex BOTH IP/OP $812.00 $600.88 $0.00 $649.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $602.67 $602.67 $625.89 $0.00 $169.22 $0.00 $0.00 $0.00 $0.00 $406.00 $643.10 $649.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008148 EAP Custom 27008148 12 Ti End Cap T40 Sdrv 20mm Ex BOTH IP/OP $682.00 $504.68 $0.00 $545.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $506.18 $506.18 $525.69 $0.00 $142.13 $0.00 $0.00 $0.00 $0.00 $341.00 $540.14 $545.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008149 EAP Custom 27008149 12 Ti End Cap T40 Sdrv 20mm Ex BOTH IP/OP $812.00 $600.88 $0.00 $649.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $602.67 $602.67 $625.89 $0.00 $169.22 $0.00 $0.00 $0.00 $0.00 $406.00 $643.10 $649.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008150 EAP Custom 27008150 16 Ti End Cap T40 Sdrv 5m Ext BOTH IP/OP $682.00 $504.68 $0.00 $545.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $506.18 $506.18 $525.69 $0.00 $142.13 $0.00 $0.00 $0.00 $0.00 $341.00 $540.14 $545.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008151 EAP Custom 27008151 16m Ti End Cap T40 Sdrv 5m Ext BOTH IP/OP $812.00 $600.88 $0.00 $649.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $602.67 $602.67 $625.89 $0.00 $169.22 $0.00 $0.00 $0.00 $0.00 $406.00 $643.10 $649.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008152 EAP Custom 27008152 16m Ti End Cap T40 Sdrv 10mm BOTH IP/OP $682.00 $504.68 $0.00 $545.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $506.18 $506.18 $525.69 $0.00 $142.13 $0.00 $0.00 $0.00 $0.00 $341.00 $540.14 $545.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008153 EAP Custom 27008153 16m Ti End Cap T40 Sdrv 10mm BOTH IP/OP $812.00 $600.88 $0.00 $649.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $602.67 $602.67 $625.89 $0.00 $169.22 $0.00 $0.00 $0.00 $0.00 $406.00 $643.10 $649.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008154 EAP Custom 27008154 16m Ti End Cap T40 Sdrv 15mm BOTH IP/OP $682.00 $504.68 $0.00 $545.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $506.18 $506.18 $525.69 $0.00 $142.13 $0.00 $0.00 $0.00 $0.00 $341.00 $540.14 $545.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008155 EAP Custom 27008155 16m Ti End Cap T40 Sdrv 15mm BOTH IP/OP $812.00 $600.88 $0.00 $649.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $602.67 $602.67 $625.89 $0.00 $169.22 $0.00 $0.00 $0.00 $0.00 $406.00 $643.10 $649.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008156 EAP Custom 27008156 16 Ti End Cap T40 Sdrv 20mm Ex BOTH IP/OP $682.00 $504.68 $0.00 $545.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $506.18 $506.18 $525.69 $0.00 $142.13 $0.00 $0.00 $0.00 $0.00 $341.00 $540.14 $545.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008157 EAP Custom 27008157 16 Ti End Cap T40 Sdrv 20mm Ex BOTH IP/OP $812.00 $600.88 $0.00 $649.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $602.67 $602.67 $625.89 $0.00 $169.22 $0.00 $0.00 $0.00 $0.00 $406.00 $643.10 $649.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008185 EAP Custom 27008185 10ti Lat En Fem Nl-ex/300m-480 BOTH IP/OP "$6,829.00 " "$5,053.46" $0.00 "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,263.79" $0.00 "$1,423.16" $0.00 $0.00 $0.00 $0.00 "$3,414.50" "$5,408.57" "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008186 EAP Custom 27008186 11ti Lat En Fem Nl-ex/300m-480 BOTH IP/OP "$6,829.00 " "$5,053.46" $0.00 "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,263.79" $0.00 "$1,423.16" $0.00 $0.00 $0.00 $0.00 "$3,414.50" "$5,408.57" "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008187 EAP Custom 27008187 11ti Lat En Fem Nl-ex/300m-480 BOTH IP/OP "$6,829.00 " "$5,053.46" $0.00 "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,263.79" $0.00 "$1,423.16" $0.00 $0.00 $0.00 $0.00 "$3,414.50" "$5,408.57" "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008188 EAP Custom 27008188 12 Ti Lat En Fem Nl-ex/300-480 BOTH IP/OP "$6,829.00 " "$5,053.46" $0.00 "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,263.79" $0.00 "$1,423.16" $0.00 $0.00 $0.00 $0.00 "$3,414.50" "$5,408.57" "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008189 EAP Custom 27008189 12 Ti Lat En Fem Nl-ex/300-480 BOTH IP/OP "$6,829.00 " "$5,053.46" $0.00 "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,263.79" $0.00 "$1,423.16" $0.00 $0.00 $0.00 $0.00 "$3,414.50" "$5,408.57" "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008190 EAP Custom 27008190 13ti Lat Ent Fem Nl-ex/300m480 BOTH IP/OP "$6,829.00 " "$5,053.46" $0.00 "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,263.79" $0.00 "$1,423.16" $0.00 $0.00 $0.00 $0.00 "$3,414.50" "$5,408.57" "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008191 EAP Custom 27008191 13ti Lat Ent Fem Nl-ex/300m480 BOTH IP/OP "$6,829.00 " "$5,053.46" $0.00 "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,263.79" $0.00 "$1,423.16" $0.00 $0.00 $0.00 $0.00 "$3,414.50" "$5,408.57" "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008192 EAP Custom 27008192 14ti Lat Ent Fem Nl-ex/300m480 BOTH IP/OP "$6,829.00 " "$5,053.46" $0.00 "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,263.79" $0.00 "$1,423.16" $0.00 $0.00 $0.00 $0.00 "$3,414.50" "$5,408.57" "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008193 EAP Custom 27008193 14ti Lat Ent Fem Nl-ex/300m480 BOTH IP/OP "$6,829.00 " "$5,053.46" $0.00 "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,263.79" $0.00 "$1,423.16" $0.00 $0.00 $0.00 $0.00 "$3,414.50" "$5,408.57" "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008194 EAP Custom 27008194 15ti Lat Ent Fem Nl-ex/300m480 BOTH IP/OP "$6,829.00 " "$5,053.46" $0.00 "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,263.79" $0.00 "$1,423.16" $0.00 $0.00 $0.00 $0.00 "$3,414.50" "$5,408.57" "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008195 EAP Custom 27008195 15ti Lat Ent Fem Nl-ex/300m480 BOTH IP/OP "$6,829.00 " "$5,053.46" $0.00 "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,263.79" $0.00 "$1,423.16" $0.00 $0.00 $0.00 $0.00 "$3,414.50" "$5,408.57" "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008196 EAP Custom 27008196 16ti Lat Ent Fem Nl-ex/300m480 BOTH IP/OP "$6,829.00 " "$5,053.46" $0.00 "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,263.79" $0.00 "$1,423.16" $0.00 $0.00 $0.00 $0.00 "$3,414.50" "$5,408.57" "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008197 EAP Custom 27008197 16ti Lat Ent Fem Nl-ex/300m480 BOTH IP/OP "$6,829.00 " "$5,053.46" $0.00 "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,263.79" $0.00 "$1,423.16" $0.00 $0.00 $0.00 $0.00 "$3,414.50" "$5,408.57" "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008198 EAP Custom 27008198 Ti En Cp W/t40 Sdr 0m Ext F/t BOTH IP/OP $682.00 $504.68 $0.00 $545.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $506.18 $506.18 $525.69 $0.00 $142.13 $0.00 $0.00 $0.00 $0.00 $341.00 $540.14 $545.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008199 EAP Custom 27008199 Ti En Cap W/t40 Sdr 0m Ext F/t BOTH IP/OP $812.00 $600.88 $0.00 $649.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $602.67 $602.67 $625.89 $0.00 $169.22 $0.00 $0.00 $0.00 $0.00 $406.00 $643.10 $649.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008200 EAP Custom 27008200 Ti En Cap W/t40 Sdr 5m Ext F/t BOTH IP/OP $882.00 $652.68 $0.00 $705.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $654.62 $654.62 $679.85 $0.00 $183.81 $0.00 $0.00 $0.00 $0.00 $441.00 $698.54 $705.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008201 EAP Custom 27008201 Ti En Cap W/t40 Sdr 5m Ext-ste BOTH IP/OP "$1,010.00 " $747.40 $0.00 $808.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $749.62 $749.62 $778.51 $0.00 $210.48 $0.00 $0.00 $0.00 $0.00 $505.00 $799.92 $808.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008202 EAP Custom 27008202 Ti En Cap W/ T40 Sdr Ext F/ti BOTH IP/OP $882.00 $652.68 $0.00 $705.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $654.62 $654.62 $679.85 $0.00 $183.81 $0.00 $0.00 $0.00 $0.00 $441.00 $698.54 $705.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008203 EAP Custom 27008203 Ti En Cap W/t40 Sdr 10m Ext-st BOTH IP/OP "$1,010.00 " $747.40 $0.00 $808.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $749.62 $749.62 $778.51 $0.00 $210.48 $0.00 $0.00 $0.00 $0.00 $505.00 $799.92 $808.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008204 EAP Custom 27008204 Ti En Cap W/t40 Sdr 15m Ext BOTH IP/OP $882.00 $652.68 $0.00 $705.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $654.62 $654.62 $679.85 $0.00 $183.81 $0.00 $0.00 $0.00 $0.00 $441.00 $698.54 $705.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008205 EAP Custom 27008205 Ti En Cap W/t40 Sdr 15m Ext-st BOTH IP/OP "$1,010.00 " $747.40 $0.00 $808.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $749.62 $749.62 $778.51 $0.00 $210.48 $0.00 $0.00 $0.00 $0.00 $505.00 $799.92 $808.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008206 EAP Custom 27008206 Ti En Cap Tib Nl-ex T40 Sdr 0m BOTH IP/OP $682.00 $504.68 $0.00 $545.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $506.18 $506.18 $525.69 $0.00 $142.13 $0.00 $0.00 $0.00 $0.00 $341.00 $540.14 $545.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008207 EAP Custom 27008207 Ti En Cap Tib Nl-ex T40 Sdr 0 BOTH IP/OP $812.00 $600.88 $0.00 $649.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $602.67 $602.67 $625.89 $0.00 $169.22 $0.00 $0.00 $0.00 $0.00 $406.00 $643.10 $649.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008208 EAP Custom 27008208 Ti En Cap Tib Nl-ex T40 Sdr 5m BOTH IP/OP $882.00 $652.68 $0.00 $705.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $654.62 $654.62 $679.85 $0.00 $183.81 $0.00 $0.00 $0.00 $0.00 $441.00 $698.54 $705.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008209 EAP Custom 27008209 Ti En Cap Tib Nl-ex T40 Sdr 5m BOTH IP/OP "$1,010.00 " $747.40 $0.00 $808.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $749.62 $749.62 $778.51 $0.00 $210.48 $0.00 $0.00 $0.00 $0.00 $505.00 $799.92 $808.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008210 EAP Custom 27008210 Ti En Cap Tib Nl-ex T40 Sdr 10 BOTH IP/OP $882.00 $652.68 $0.00 $705.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $654.62 $654.62 $679.85 $0.00 $183.81 $0.00 $0.00 $0.00 $0.00 $441.00 $698.54 $705.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008211 EAP Custom 27008211 Ti En Cap Tib Nl-ex T40 Sdr 10 BOTH IP/OP "$1,010.00 " $747.40 $0.00 $808.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $749.62 $749.62 $778.51 $0.00 $210.48 $0.00 $0.00 $0.00 $0.00 $505.00 $799.92 $808.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008212 EAP Custom 27008212 Ti En Cap Tib Nl-ex T40 Sdr 15 BOTH IP/OP $882.00 $652.68 $0.00 $705.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $654.62 $654.62 $679.85 $0.00 $183.81 $0.00 $0.00 $0.00 $0.00 $441.00 $698.54 $705.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008213 EAP Custom 27008213 Ti En Cap Tib Nl-ex T40 Sdr 15 BOTH IP/OP "$1,010.00 " $747.40 $0.00 $808.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $749.62 $749.62 $778.51 $0.00 $210.48 $0.00 $0.00 $0.00 $0.00 $505.00 $799.92 $808.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008216 EAP Custom 27008216 10m Ti Can Tib Nl-ex/255-435mm BOTH IP/OP "$6,110.00 " "$4,521.40" $0.00 "$4,888.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$4,709.59" $0.00 "$1,273.32" $0.00 $0.00 $0.00 $0.00 "$3,055.00" "$4,839.12" "$4,888.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008217 EAP Custom 27008217 12m Ti Can Tib Nl-ex/255-435mm BOTH IP/OP "$6,110.00 " "$4,521.40" $0.00 "$4,888.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$4,709.59" $0.00 "$1,273.32" $0.00 $0.00 $0.00 $0.00 "$3,055.00" "$4,839.12" "$4,888.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008219 EAP Custom 27008219 Ti En Cap T25 Sdr Hndft Art Nl BOTH IP/OP $712.00 $526.88 $0.00 $569.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $528.45 $528.45 $548.81 $0.00 $148.38 $0.00 $0.00 $0.00 $0.00 $356.00 $563.90 $569.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008220 EAP Custom 27008220 Ti En Cap T25 Sdr Hndft Art Nl BOTH IP/OP $842.00 $623.08 $0.00 $673.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $624.93 $624.93 $649.01 $0.00 $175.47 $0.00 $0.00 $0.00 $0.00 $421.00 $666.86 $673.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008221 EAP Custom 27008221 Ti En Cap T25 Sdr Hndft Art Nl BOTH IP/OP $712.00 $526.88 $0.00 $569.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $528.45 $528.45 $548.81 $0.00 $148.38 $0.00 $0.00 $0.00 $0.00 $356.00 $563.90 $569.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008222 EAP Custom 27008222 Ti En Cap T25 Sdr Hndft Art Nl BOTH IP/OP $842.00 $623.08 $0.00 $673.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $624.93 $624.93 $649.01 $0.00 $175.47 $0.00 $0.00 $0.00 $0.00 $421.00 $666.86 $673.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008223 EAP Custom 27008223 10ti Hft Art Can Nl-ex150-240m BOTH IP/OP "$6,453.00 " "$4,775.22" $0.00 "$5,162.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$4,973.97" $0.00 "$1,344.81" $0.00 $0.00 $0.00 $0.00 "$3,226.50" "$5,110.78" "$5,162.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008224 EAP Custom 27008224 Ti En Cap T40 Sdr 0m Ext Retr BOTH IP/OP $682.00 $504.68 $0.00 $545.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $506.18 $506.18 $525.69 $0.00 $142.13 $0.00 $0.00 $0.00 $0.00 $341.00 $540.14 $545.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008225 EAP Custom 27008225 Ti Spir Bld 45m Ti Retr Fem Nl BOTH IP/OP "$2,318.00 " "$1,715.32" $0.00 "$1,854.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,720.42" "$1,720.42" "$1,786.71" $0.00 $483.07 $0.00 $0.00 $0.00 $0.00 "$1,159.00" "$1,835.86" "$1,854.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008226 EAP Custom 27008226 Ti Spir Bld 50m Ti Retr Fem Nl BOTH IP/OP "$2,318.00 " "$1,715.32" $0.00 "$1,854.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,720.42" "$1,720.42" "$1,786.71" $0.00 $483.07 $0.00 $0.00 $0.00 $0.00 "$1,159.00" "$1,835.86" "$1,854.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008227 EAP Custom 27008227 Ti Spir Bld 50m-ster F/ti Retr BOTH IP/OP "$2,447.00 " "$1,810.78" $0.00 "$1,957.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,816.16" "$1,816.16" "$1,886.15" $0.00 $509.95 $0.00 $0.00 $0.00 $0.00 "$1,223.50" "$1,938.02" "$1,957.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008228 EAP Custom 27008228 Ti Spir Bld 55m Ti Retr Fem BOTH IP/OP "$2,318.00 " "$1,715.32" $0.00 "$1,854.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,720.42" "$1,720.42" "$1,786.71" $0.00 $483.07 $0.00 $0.00 $0.00 $0.00 "$1,159.00" "$1,835.86" "$1,854.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008229 EAP Custom 27008229 Ti Spir Bld 55m-ster F/ti Retr BOTH IP/OP "$2,447.00 " "$1,810.78" $0.00 "$1,957.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,816.16" "$1,816.16" "$1,886.15" $0.00 $509.95 $0.00 $0.00 $0.00 $0.00 "$1,223.50" "$1,938.02" "$1,957.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008230 EAP Custom 27008230 Ti Spir Bld 65m Ti Retr Fem Nl BOTH IP/OP "$2,318.00 " "$1,715.32" $0.00 "$1,854.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,720.42" "$1,720.42" "$1,786.71" $0.00 $483.07 $0.00 $0.00 $0.00 $0.00 "$1,159.00" "$1,835.86" "$1,854.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008231 EAP Custom 27008231 Ti Spir Bld 65f/ti Ret Fem Nls BOTH IP/OP "$2,447.00 " "$1,810.78" $0.00 "$1,957.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,816.16" "$1,816.16" "$1,886.15" $0.00 $509.95 $0.00 $0.00 $0.00 $0.00 "$1,223.50" "$1,938.02" "$1,957.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008232 EAP Custom 27008232 Ti Spir Bld 70m Ti Retr Fem Nl BOTH IP/OP "$2,318.00 " "$1,715.32" $0.00 "$1,854.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,720.42" "$1,720.42" "$1,786.71" $0.00 $483.07 $0.00 $0.00 $0.00 $0.00 "$1,159.00" "$1,835.86" "$1,854.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008233 EAP Custom 27008233 Ti Spir Bld 70m F/ti Retr Fem BOTH IP/OP "$2,447.00 " "$1,810.78" $0.00 "$1,957.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,816.16" "$1,816.16" "$1,886.15" $0.00 $509.95 $0.00 $0.00 $0.00 $0.00 "$1,223.50" "$1,938.02" "$1,957.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008234 EAP Custom 27008234 Ti Spir Bld 75m Ti Retr Fem Nl BOTH IP/OP "$2,318.00 " "$1,715.32" $0.00 "$1,854.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,720.42" "$1,720.42" "$1,786.71" $0.00 $483.07 $0.00 $0.00 $0.00 $0.00 "$1,159.00" "$1,835.86" "$1,854.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008235 EAP Custom 27008235 Ti Spir Bld 75 F/ti Ret Fem Nl BOTH IP/OP "$2,447.00 " "$1,810.78" $0.00 "$1,957.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,816.16" "$1,816.16" "$1,886.15" $0.00 $509.95 $0.00 $0.00 $0.00 $0.00 "$1,223.50" "$1,938.02" "$1,957.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008236 EAP Custom 27008236 Ti Spir Bld 80m Ti Retr Fem Nl BOTH IP/OP "$2,318.00 " "$1,715.32" $0.00 "$1,854.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,720.42" "$1,720.42" "$1,786.71" $0.00 $483.07 $0.00 $0.00 $0.00 $0.00 "$1,159.00" "$1,835.86" "$1,854.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008237 EAP Custom 27008237 Ti Spir Bld 80 F/ti Ret Fem Nl BOTH IP/OP "$2,447.00 " "$1,810.78" $0.00 "$1,957.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,816.16" "$1,816.16" "$1,886.15" $0.00 $509.95 $0.00 $0.00 $0.00 $0.00 "$1,223.50" "$1,938.02" "$1,957.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008238 EAP Custom 27008238 Ti Spir Bld 85 Ti Retr Fem Nl BOTH IP/OP "$2,318.00 " "$1,715.32" $0.00 "$1,854.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,720.42" "$1,720.42" "$1,786.71" $0.00 $483.07 $0.00 $0.00 $0.00 $0.00 "$1,159.00" "$1,835.86" "$1,854.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008239 EAP Custom 27008239 Ti Spir Bld 85m F/ti Retr Fem BOTH IP/OP "$2,447.00 " "$1,810.78" $0.00 "$1,957.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,816.16" "$1,816.16" "$1,886.15" $0.00 $509.95 $0.00 $0.00 $0.00 $0.00 "$1,223.50" "$1,938.02" "$1,957.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008240 EAP Custom 27008240 Ti Spir Bld 90m Ti Retr Fem Nl BOTH IP/OP "$2,318.00 " "$1,715.32" $0.00 "$1,854.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,720.42" "$1,720.42" "$1,786.71" $0.00 $483.07 $0.00 $0.00 $0.00 $0.00 "$1,159.00" "$1,835.86" "$1,854.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008241 EAP Custom 27008241 Ti Spir Bld 90m F/ti Retr Fem BOTH IP/OP "$2,447.00 " "$1,810.78" $0.00 "$1,957.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,816.16" "$1,816.16" "$1,886.15" $0.00 $509.95 $0.00 $0.00 $0.00 $0.00 "$1,223.50" "$1,938.02" "$1,957.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008242 EAP Custom 27008242 Ti Spir Bld 95m Ti Retr Fem Nl BOTH IP/OP "$2,318.00 " "$1,715.32" $0.00 "$1,854.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,720.42" "$1,720.42" "$1,786.71" $0.00 $483.07 $0.00 $0.00 $0.00 $0.00 "$1,159.00" "$1,835.86" "$1,854.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008243 EAP Custom 27008243 Ti Spir Bld 100m Ti Retr Fem BOTH IP/OP "$2,318.00 " "$1,715.32" $0.00 "$1,854.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,720.42" "$1,720.42" "$1,786.71" $0.00 $483.07 $0.00 $0.00 $0.00 $0.00 "$1,159.00" "$1,835.86" "$1,854.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008244 EAP Custom 27008244 Ti Spir Bld 100m-st F/ti Ret BOTH IP/OP "$2,447.00 " "$1,810.78" $0.00 "$1,957.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,816.16" "$1,816.16" "$1,886.15" $0.00 $509.95 $0.00 $0.00 $0.00 $0.00 "$1,223.50" "$1,938.02" "$1,957.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008247 EAP Custom 27008247 10ti Can Ret Fem Nl-ex/160-280 BOTH IP/OP "$6,897.00 " "$5,103.78" $0.00 "$5,517.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,316.21" $0.00 "$1,437.33" $0.00 $0.00 $0.00 $0.00 "$3,448.50" "$5,462.42" "$5,517.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008248 EAP Custom 27008248 10ti Can Ret/ant Fem Nl300-480 BOTH IP/OP "$6,897.00 " "$5,103.78" $0.00 "$5,517.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,316.21" $0.00 "$1,437.33" $0.00 $0.00 $0.00 $0.00 "$3,448.50" "$5,462.42" "$5,517.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008249 EAP Custom 27008249 11ti Can Ret Fem Nl-ex/160-280 BOTH IP/OP "$6,897.00 " "$5,103.78" $0.00 "$5,517.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,316.21" $0.00 "$1,437.33" $0.00 $0.00 $0.00 $0.00 "$3,448.50" "$5,462.42" "$5,517.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008250 EAP Custom 27008250 12mmti Can Retr Fem Nl 160-280 BOTH IP/OP "$6,897.00 " "$5,103.78" $0.00 "$5,517.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,316.21" $0.00 "$1,437.33" $0.00 $0.00 $0.00 $0.00 "$3,448.50" "$5,462.42" "$5,517.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008251 EAP Custom 27008251 13ti Can Retr Fem Nl-ex160-280 BOTH IP/OP "$6,897.00 " "$5,103.78" $0.00 "$5,517.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,316.21" $0.00 "$1,437.33" $0.00 $0.00 $0.00 $0.00 "$3,448.50" "$5,462.42" "$5,517.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008252 EAP Custom 27008252 13ti Can Ret/ant Fem Nl300-480 BOTH IP/OP "$6,897.00 " "$5,103.78" $0.00 "$5,517.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,316.21" $0.00 "$1,437.33" $0.00 $0.00 $0.00 $0.00 "$3,448.50" "$5,462.42" "$5,517.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008253 EAP Custom 27008253 14ti Can Retr Fem Nl-ex160-280 BOTH IP/OP "$6,897.00 " "$5,103.78" $0.00 "$5,517.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,316.21" $0.00 "$1,437.33" $0.00 $0.00 $0.00 $0.00 "$3,448.50" "$5,462.42" "$5,517.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008254 EAP Custom 27008254 14ti Can Ret/ant Fem Nl300-480 BOTH IP/OP "$6,897.00 " "$5,103.78" $0.00 "$5,517.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,316.21" $0.00 "$1,437.33" $0.00 $0.00 $0.00 $0.00 "$3,448.50" "$5,462.42" "$5,517.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008255 EAP Custom 27008255 15ti Can Retr Fem Nl-160-280mm BOTH IP/OP "$6,897.00 " "$5,103.78" $0.00 "$5,517.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,316.21" $0.00 "$1,437.33" $0.00 $0.00 $0.00 $0.00 "$3,448.50" "$5,462.42" "$5,517.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008256 EAP Custom 27008256 15ti Can Ret/ant Fem Nl300-480 BOTH IP/OP "$6,897.00 " "$5,103.78" $0.00 "$5,517.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,316.21" $0.00 "$1,437.33" $0.00 $0.00 $0.00 $0.00 "$3,448.50" "$5,462.42" "$5,517.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008258 EAP Custom 27008258 10ti Can Lat Ent Fem Nl300-480 BOTH IP/OP "$6,829.00 " "$5,053.46" $0.00 "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,263.79" $0.00 "$1,423.16" $0.00 $0.00 $0.00 $0.00 "$3,414.50" "$5,408.57" "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008259 EAP Custom 27008259 10ti Can Lat Ent Fem Nl300-480 BOTH IP/OP "$6,829.00 " "$5,053.46" $0.00 "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,263.79" $0.00 "$1,423.16" $0.00 $0.00 $0.00 $0.00 "$3,414.50" "$5,408.57" "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008260 EAP Custom 27008260 11ti Can Lat Ent Fem Nl300-480 BOTH IP/OP "$6,829.00 " "$5,053.46" $0.00 "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,263.79" $0.00 "$1,423.16" $0.00 $0.00 $0.00 $0.00 "$3,414.50" "$5,408.57" "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008261 EAP Custom 27008261 12ti Can Lat Ent Fem Nl300-480 BOTH IP/OP "$6,829.00 " "$5,053.46" $0.00 "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,263.79" $0.00 "$1,423.16" $0.00 $0.00 $0.00 $0.00 "$3,414.50" "$5,408.57" "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008262 EAP Custom 27008262 12ti Can Lat Ent Fem Nl300-480 BOTH IP/OP "$6,829.00 " "$5,053.46" $0.00 "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,263.79" $0.00 "$1,423.16" $0.00 $0.00 $0.00 $0.00 "$3,414.50" "$5,408.57" "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008263 EAP Custom 27008263 13ti Can Lat Ent Fem Nl300-480 BOTH IP/OP "$6,829.00 " "$5,053.46" $0.00 "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,263.79" $0.00 "$1,423.16" $0.00 $0.00 $0.00 $0.00 "$3,414.50" "$5,408.57" "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008264 EAP Custom 27008264 13ti Can Lat Ent Fem Nl300-480 BOTH IP/OP "$6,829.00 " "$5,053.46" $0.00 "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,263.79" $0.00 "$1,423.16" $0.00 $0.00 $0.00 $0.00 "$3,414.50" "$5,408.57" "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008265 EAP Custom 27008265 14ti Can Lat Ent Fem Nl300-480 BOTH IP/OP "$6,829.00 " "$5,053.46" $0.00 "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,263.79" $0.00 "$1,423.16" $0.00 $0.00 $0.00 $0.00 "$3,414.50" "$5,408.57" "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008266 EAP Custom 27008266 14ti Can Lat Ent Fem Nl300-480 BOTH IP/OP "$6,829.00 " "$5,053.46" $0.00 "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,263.79" $0.00 "$1,423.16" $0.00 $0.00 $0.00 $0.00 "$3,414.50" "$5,408.57" "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008267 EAP Custom 27008267 15ti Can Lat Ent Fem Nl300-480 BOTH IP/OP "$6,829.00 " "$5,053.46" $0.00 "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,263.79" $0.00 "$1,423.16" $0.00 $0.00 $0.00 $0.00 "$3,414.50" "$5,408.57" "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008268 EAP Custom 27008268 15ti Can Lat Ent Fem Nl300-480 BOTH IP/OP "$6,829.00 " "$5,053.46" $0.00 "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,263.79" $0.00 "$1,423.16" $0.00 $0.00 $0.00 $0.00 "$3,414.50" "$5,408.57" "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008269 EAP Custom 27008269 16ti Can Lat Ent Fem Nl300-480 BOTH IP/OP "$6,829.00 " "$5,053.46" $0.00 "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,263.79" $0.00 "$1,423.16" $0.00 $0.00 $0.00 $0.00 "$3,414.50" "$5,408.57" "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008270 EAP Custom 27008270 16ti Can Lat Ent Fem Nl300-480 BOTH IP/OP "$6,829.00 " "$5,053.46" $0.00 "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,263.79" $0.00 "$1,423.16" $0.00 $0.00 $0.00 $0.00 "$3,414.50" "$5,408.57" "$5,463.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008275 EAP Custom 27008275 T15/2.5m Hex Ti Cerclage Buttn BOTH IP/OP $652.00 $482.48 $0.00 $521.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $483.91 $483.91 $502.56 $0.00 $135.88 $0.00 $0.00 $0.00 $0.00 $326.00 $516.38 $521.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008276 EAP Custom 27008276 T25/3.5m Hex Ti Cerclage Buttn BOTH IP/OP $652.00 $482.48 $0.00 $521.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $483.91 $483.91 $502.56 $0.00 $135.88 $0.00 $0.00 $0.00 $0.00 $326.00 $516.38 $521.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008281 EAP Custom 27008281 Saw Bld 95x19 0.89m Cut Thknes BOTH IP/OP $329.00 $243.46 $0.00 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $244.18 $244.18 $253.59 $0.00 $68.56 $0.00 $0.00 $0.00 $0.00 $164.50 $260.57 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008282 EAP Custom 27008282 Saw Bld 95x19 1.19m Cut Thknes BOTH IP/OP $329.00 $243.46 $0.00 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $244.18 $244.18 $253.59 $0.00 $68.56 $0.00 $0.00 $0.00 $0.00 $164.50 $260.57 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008283 EAP Custom 27008283 Saw Bld 95x19 1.27m Cut Thknes BOTH IP/OP $329.00 $243.46 $0.00 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $244.18 $244.18 $253.59 $0.00 $68.56 $0.00 $0.00 $0.00 $0.00 $164.50 $260.57 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008284 EAP Custom 27008284 Saw Bld 95x19 1.37m Cut Thknes BOTH IP/OP $329.00 $243.46 $0.00 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $244.18 $244.18 $253.59 $0.00 $68.56 $0.00 $0.00 $0.00 $0.00 $164.50 $260.57 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008285 EAP Custom 27008285 Saw Bld 95x 19 1.47 Cut Thknes BOTH IP/OP $329.00 $243.46 $0.00 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $244.18 $244.18 $253.59 $0.00 $68.56 $0.00 $0.00 $0.00 $0.00 $164.50 $260.57 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008286 EAP Custom 27008286 Saw Bld 80x19 0.89 Cut Thkness BOTH IP/OP $329.00 $243.46 $0.00 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $244.18 $244.18 $253.59 $0.00 $68.56 $0.00 $0.00 $0.00 $0.00 $164.50 $260.57 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008287 EAP Custom 27008287 Saw Bld 95x19 1.00 Cut Thkness BOTH IP/OP $329.00 $243.46 $0.00 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $244.18 $244.18 $253.59 $0.00 $68.56 $0.00 $0.00 $0.00 $0.00 $164.50 $260.57 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008288 EAP Custom 27008288 Saw Bld 95 X 19 1.07cut Thknes BOTH IP/OP $329.00 $243.46 $0.00 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $244.18 $244.18 $253.59 $0.00 $68.56 $0.00 $0.00 $0.00 $0.00 $164.50 $260.57 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008289 EAP Custom 27008289 Saw Bld 95x25 0.89 Cut Thkness BOTH IP/OP $329.00 $243.46 $0.00 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $244.18 $244.18 $253.59 $0.00 $68.56 $0.00 $0.00 $0.00 $0.00 $164.50 $260.57 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008290 EAP Custom 27008290 Saw Bld 95x25 1.19 Cut Thcknes BOTH IP/OP $329.00 $243.46 $0.00 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $244.18 $244.18 $253.59 $0.00 $68.56 $0.00 $0.00 $0.00 $0.00 $164.50 $260.57 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008291 EAP Custom 27008291 Saw Bld 95x25 1.27 Cut Thcknes BOTH IP/OP $329.00 $243.46 $0.00 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $244.18 $244.18 $253.59 $0.00 $68.56 $0.00 $0.00 $0.00 $0.00 $164.50 $260.57 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008292 EAP Custom 27008292 Saw Bld 95x25 1.37 Cut Thcknes BOTH IP/OP $329.00 $243.46 $0.00 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $244.18 $244.18 $253.59 $0.00 $68.56 $0.00 $0.00 $0.00 $0.00 $164.50 $260.57 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008293 EAP Custom 27008293 Saw Bld 95x25 1.47cut Thckness BOTH IP/OP $329.00 $243.46 $0.00 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $244.18 $244.18 $253.59 $0.00 $68.56 $0.00 $0.00 $0.00 $0.00 $164.50 $260.57 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008294 EAP Custom 27008294 Saw Blade 95mm X 25mm 1.00mm BOTH IP/OP $329.00 $243.46 $0.00 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $244.18 $244.18 $253.59 $0.00 $68.56 $0.00 $0.00 $0.00 $0.00 $164.50 $260.57 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008295 EAP Custom 27008295 Saw Blade 95mm X 25mm 1.07mm BOTH IP/OP $329.00 $243.46 $0.00 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $244.18 $244.18 $253.59 $0.00 $68.56 $0.00 $0.00 $0.00 $0.00 $164.50 $260.57 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008296 EAP Custom 27008296 Saw Blade 90mm X 12.5mm 0.89m BOTH IP/OP $329.00 $243.46 $0.00 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $244.18 $244.18 $253.59 $0.00 $68.56 $0.00 $0.00 $0.00 $0.00 $164.50 $260.57 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008297 EAP Custom 27008297 Saw Blade 90mm X 12.5mm 1.19m BOTH IP/OP $329.00 $243.46 $0.00 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $244.18 $244.18 $253.59 $0.00 $68.56 $0.00 $0.00 $0.00 $0.00 $164.50 $260.57 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008298 EAP Custom 27008298 Saw Blade 90mm X 12.5mm 1.27m BOTH IP/OP $329.00 $243.46 $0.00 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $244.18 $244.18 $253.59 $0.00 $68.56 $0.00 $0.00 $0.00 $0.00 $164.50 $260.57 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008299 EAP Custom 27008299 Saw Blade 90mm X 12.5mm 1.37m BOTH IP/OP $329.00 $243.46 $0.00 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $244.18 $244.18 $253.59 $0.00 $68.56 $0.00 $0.00 $0.00 $0.00 $164.50 $260.57 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008300 EAP Custom 27008300 Saw Blade 90mm X 12.5mm 1.47m BOTH IP/OP $329.00 $243.46 $0.00 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $244.18 $244.18 $253.59 $0.00 $68.56 $0.00 $0.00 $0.00 $0.00 $164.50 $260.57 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008301 EAP Custom 27008301 Saw Blade 90m X 19-12.5m 0.89m BOTH IP/OP $329.00 $243.46 $0.00 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $244.18 $244.18 $253.59 $0.00 $68.56 $0.00 $0.00 $0.00 $0.00 $164.50 $260.57 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008302 EAP Custom 27008302 Saw Blade 90m X19-12.5mm 1.19m BOTH IP/OP $328.00 $242.72 $0.00 $262.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $243.44 $243.44 $252.82 $0.00 $68.36 $0.00 $0.00 $0.00 $0.00 $164.00 $259.78 $262.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008303 EAP Custom 27008303 Saw Blade 90mx19-12.5mm 1.27m BOTH IP/OP $329.00 $243.46 $0.00 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $244.18 $244.18 $253.59 $0.00 $68.56 $0.00 $0.00 $0.00 $0.00 $164.50 $260.57 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008304 EAP Custom 27008304 Saw Blade 90m X19-12.5m 1.37m BOTH IP/OP $310.00 $229.40 $0.00 $248.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $230.08 $230.08 $238.95 $0.00 $64.60 $0.00 $0.00 $0.00 $0.00 $155.00 $245.52 $248.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008305 EAP Custom 27008305 Saw Blade 90mx19-12.5mm 1.47m BOTH IP/OP $329.00 $243.46 $0.00 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $244.18 $244.18 $253.59 $0.00 $68.56 $0.00 $0.00 $0.00 $0.00 $164.50 $260.57 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008306 EAP Custom 27008306 Saw Blade 90mx19-12.5mm 1.00m BOTH IP/OP $329.00 $243.46 $0.00 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $244.18 $244.18 $253.59 $0.00 $68.56 $0.00 $0.00 $0.00 $0.00 $164.50 $260.57 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008307 EAP Custom 27008307 Saw Blade 90mm X 12.5mm 1.00m BOTH IP/OP $329.00 $243.46 $0.00 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $244.18 $244.18 $253.59 $0.00 $68.56 $0.00 $0.00 $0.00 $0.00 $164.50 $260.57 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008308 EAP Custom 27008308 Saw Blade 60mm X 25mm 0.89mm BOTH IP/OP $329.00 $243.46 $0.00 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $244.18 $244.18 $253.59 $0.00 $68.56 $0.00 $0.00 $0.00 $0.00 $164.50 $260.57 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008309 EAP Custom 27008309 Plan&reduct Tech In Fx Surgery BOTH IP/OP $781.00 $577.94 $0.00 $624.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $579.66 $579.66 $601.99 $0.00 $162.76 $0.00 $0.00 $0.00 $0.00 $390.50 $618.55 $624.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008312 EAP Custom 27008312 The Rational Operative Fx Care BOTH IP/OP $781.00 $577.94 $0.00 $624.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $579.66 $579.66 $601.99 $0.00 $162.76 $0.00 $0.00 $0.00 $0.00 $390.50 $618.55 $624.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008316 EAP Custom 27008316 Minimax Fracture Fixation BOTH IP/OP $630.00 $466.20 $0.00 $504.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $467.59 $467.59 $485.60 $0.00 $131.29 $0.00 $0.00 $0.00 $0.00 $315.00 $498.96 $504.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008318 EAP Custom 27008318 Intern Fixatn Osteoporotic Bne BOTH IP/OP $538.00 $398.12 $0.00 $430.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $399.30 $399.30 $414.69 $0.00 $112.12 $0.00 $0.00 $0.00 $0.00 $269.00 $426.10 $430.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008321 EAP Custom 27008321 Oper Approach Orth Surg&trauma BOTH IP/OP $635.00 $469.90 $0.00 $508.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $471.30 $471.30 $489.46 $0.00 $132.33 $0.00 $0.00 $0.00 $0.00 $317.50 $502.92 $508.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008324 EAP Custom 27008324 1.5mm Cortex Scw 6-20mm BOTH IP/OP $83.00 $61.42 $0.00 $66.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $61.60 $61.60 $63.98 $0.00 $17.30 $0.00 $0.00 $0.00 $0.00 $41.50 $65.74 $66.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008325 EAP Custom 27008325 1.0cor Scw Self-tapg 6-14mm BOTH IP/OP $340.00 $251.60 $0.00 $272.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $252.35 $252.35 $262.07 $0.00 $70.86 $0.00 $0.00 $0.00 $0.00 $170.00 $269.28 $272.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008326 EAP Custom 27008326 1.3mm Cort Scw Slf-tapg 6-18 BOTH IP/OP $329.00 $243.46 $0.00 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $244.18 $244.18 $253.59 $0.00 $68.56 $0.00 $0.00 $0.00 $0.00 $164.50 $260.57 $263.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008327 EAP Custom 27008327 1.5mm Cort Scw Slf-tapg 6-24 BOTH IP/OP $97.00 $71.78 $0.00 $77.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $71.99 $71.99 $74.77 $0.00 $20.21 $0.00 $0.00 $0.00 $0.00 $48.50 $76.82 $77.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008335 EAP Custom 27008335 1.8mm Buttress Pin/12-30mm BOTH IP/OP $170.00 $125.80 $0.00 $136.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $126.17 $126.17 $131.04 $0.00 $35.43 $0.00 $0.00 $0.00 $0.00 $85.00 $134.64 $136.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008367 EAP Custom 27008367 Schuhli Assembly - 4.5 Cor Scw BOTH IP/OP "$1,039.00 " $768.86 $0.00 $831.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $771.15 $771.15 $800.86 $0.00 $216.53 $0.00 $0.00 $0.00 $0.00 $519.50 $822.89 $831.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008368 EAP Custom 27008368 Schuhli Assembly- 3.5 Cor Scw BOTH IP/OP "$1,039.00 " $768.86 $0.00 $831.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $771.15 $771.15 $800.86 $0.00 $216.53 $0.00 $0.00 $0.00 $0.00 $519.50 $822.89 $831.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008369 EAP Custom 27008369 Thrded Wash 3.0 Cannul Scw BOTH IP/OP $560.00 $414.40 $0.00 $448.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $415.63 $415.63 $431.65 $0.00 $116.70 $0.00 $0.00 $0.00 $0.00 $280.00 $443.52 $448.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008370 EAP Custom 27008370 Spiked Washer 8.0mm/3.2mm BOTH IP/OP $497.00 $367.78 $0.00 $397.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $368.87 $368.87 $383.09 $0.00 $103.57 $0.00 $0.00 $0.00 $0.00 $248.50 $393.62 $397.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008371 EAP Custom 27008371 Spiked Washer 13.5mm/4.0mm BOTH IP/OP $501.00 $370.74 $0.00 $400.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $371.84 $371.84 $386.17 $0.00 $104.41 $0.00 $0.00 $0.00 $0.00 $250.50 $396.79 $400.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008372 EAP Custom 27008372 Spiked Washer 13.5mm/5.5mm BOTH IP/OP $492.00 $364.08 $0.00 $393.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $365.16 $365.16 $379.23 $0.00 $102.53 $0.00 $0.00 $0.00 $0.00 $246.00 $389.66 $393.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008373 EAP Custom 27008373 Spher Wash/sm Oval 6.5/ 0.3mm BOTH IP/OP $608.00 $449.92 $0.00 $486.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $451.26 $451.26 $468.65 $0.00 $126.71 $0.00 $0.00 $0.00 $0.00 $304.00 $481.54 $486.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008374 EAP Custom 27008374 Spher Washer/lrg Rnd 6.5/7.3 BOTH IP/OP $608.00 $449.92 $0.00 $486.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $451.26 $451.26 $468.65 $0.00 $126.71 $0.00 $0.00 $0.00 $0.00 $304.00 $481.54 $486.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008375 EAP Custom 27008375 Nut For 4.5mm Cortex Screws BOTH IP/OP $120.00 $88.80 $0.00 $96.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $89.06 $89.06 $92.50 $0.00 $25.01 $0.00 $0.00 $0.00 $0.00 $60.00 $95.04 $96.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008376 EAP Custom 27008376 Washer 6.5mm BOTH IP/OP $109.00 $80.66 $0.00 $87.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $80.90 $80.90 $84.02 $0.00 $22.72 $0.00 $0.00 $0.00 $0.00 $54.50 $86.33 $87.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008377 EAP Custom 27008377 1.3mm Straight Plate 6 Holes BOTH IP/OP $789.00 $583.86 $0.00 $631.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $585.60 $585.60 $608.16 $0.00 $164.43 $0.00 $0.00 $0.00 $0.00 $394.50 $624.89 $631.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008378 EAP Custom 27008378 1.3mm Straight Plate 12 Holes BOTH IP/OP $996.00 $737.04 $0.00 $796.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $739.23 $739.23 $767.72 $0.00 $207.57 $0.00 $0.00 $0.00 $0.00 $498.00 $788.83 $796.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008379 EAP Custom 27008379 1.3mm Extended H-plate/right BOTH IP/OP $954.00 $705.96 $0.00 $763.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $708.06 $708.06 $735.34 $0.00 $198.81 $0.00 $0.00 $0.00 $0.00 $477.00 $755.57 $763.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008380 EAP Custom 27008380 1.3mm Extended H-plate/left BOTH IP/OP $954.00 $705.96 $0.00 $763.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $708.06 $708.06 $735.34 $0.00 $198.81 $0.00 $0.00 $0.00 $0.00 $477.00 $755.57 $763.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008381 EAP Custom 27008381 1.3mm T-plte 3 Hles Hd/ 8hles BOTH IP/OP $913.00 $675.62 $0.00 $730.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $677.63 $677.63 $703.74 $0.00 $190.27 $0.00 $0.00 $0.00 $0.00 $456.50 $723.10 $730.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008382 EAP Custom 27008382 1.3mm T-plte 4hles Head/8hles BOTH IP/OP $954.00 $705.96 $0.00 $763.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $708.06 $708.06 $735.34 $0.00 $198.81 $0.00 $0.00 $0.00 $0.00 $477.00 $755.57 $763.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008383 EAP Custom 27008383 1.3mm Y-plte 3 Hles Head/8hle BOTH IP/OP $913.00 $675.62 $0.00 $730.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $677.63 $677.63 $703.74 $0.00 $190.27 $0.00 $0.00 $0.00 $0.00 $456.50 $723.10 $730.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008384 EAP Custom 27008384 Semi-tubul Plate 2 Holes 39m BOTH IP/OP $228.00 $168.72 $0.00 $182.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $169.22 $169.22 $175.74 $0.00 $47.52 $0.00 $0.00 $0.00 $0.00 $114.00 $180.58 $182.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008385 EAP Custom 27008385 Semi-tubul Plate 3 Holes 55m BOTH IP/OP $235.00 $173.90 $0.00 $188.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $174.42 $174.42 $181.14 $0.00 $48.97 $0.00 $0.00 $0.00 $0.00 $117.50 $186.12 $188.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008386 EAP Custom 27008386 Semi-tubul Plate 4 Holes 71m BOTH IP/OP $255.00 $188.70 $0.00 $204.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $189.26 $189.26 $196.55 $0.00 $53.14 $0.00 $0.00 $0.00 $0.00 $127.50 $201.96 $204.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008387 EAP Custom 27008387 Semi-tubul Plate 5 Holes 87m BOTH IP/OP $267.00 $197.58 $0.00 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $198.17 $198.17 $205.80 $0.00 $55.64 $0.00 $0.00 $0.00 $0.00 $133.50 $211.46 $213.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008388 EAP Custom 27008388 Semi-tubulplate 6 Holes 103m BOTH IP/OP $283.00 $209.42 $0.00 $226.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $210.04 $210.04 $218.14 $0.00 $58.98 $0.00 $0.00 $0.00 $0.00 $141.50 $224.14 $226.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008389 EAP Custom 27008389 Semi-tubul Plate 7 Holes 119m BOTH IP/OP $307.00 $227.18 $0.00 $245.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $227.86 $227.86 $236.64 $0.00 $63.98 $0.00 $0.00 $0.00 $0.00 $153.50 $243.14 $245.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008390 EAP Custom 27008390 Semi-tubul Plate 8 Holes 135m BOTH IP/OP $325.00 $240.50 $0.00 $260.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $241.22 $241.22 $250.51 $0.00 $67.73 $0.00 $0.00 $0.00 $0.00 $162.50 $257.40 $260.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008391 EAP Custom 27008391 Semi-tubul Plate 9 Holes 151m BOTH IP/OP $337.00 $249.38 $0.00 $269.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $250.12 $250.12 $259.76 $0.00 $70.23 $0.00 $0.00 $0.00 $0.00 $168.50 $266.90 $269.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008392 EAP Custom 27008392 Semi-tubul Plate 10 Holes 167m BOTH IP/OP $345.00 $255.30 $0.00 $276.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $256.06 $256.06 $265.93 $0.00 $71.90 $0.00 $0.00 $0.00 $0.00 $172.50 $273.24 $276.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008393 EAP Custom 27008393 Semi-tubul Plate 11 Holes/183m BOTH IP/OP $356.00 $263.44 $0.00 $284.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $264.22 $264.22 $274.40 $0.00 $74.19 $0.00 $0.00 $0.00 $0.00 $178.00 $281.95 $284.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008394 EAP Custom 27008394 Semi-tubular Plate 12 Hles/199 BOTH IP/OP $375.00 $277.50 $0.00 $300.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $278.33 $278.33 $289.05 $0.00 $78.15 $0.00 $0.00 $0.00 $0.00 $187.50 $297.00 $300.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008662 EAP Custom 27008662 100deg Adoles Osteo Plt 50/10 BOTH IP/OP "$2,088.00 " "$1,545.12" $0.00 "$1,670.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,549.71" "$1,549.71" "$1,609.43" $0.00 $435.14 $0.00 $0.00 $0.00 $0.00 "$1,044.00" "$1,653.70" "$1,670.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008663 EAP Custom 27008663 100deg Adoles Osteo Plt 50/10 BOTH IP/OP "$2,219.00 " "$1,642.06" $0.00 "$1,775.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,646.94" "$1,646.94" "$1,710.41" $0.00 $462.44 $0.00 $0.00 $0.00 $0.00 "$1,109.50" "$1,757.45" "$1,775.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008666 EAP Custom 27008666 100deg Adoles Osteo Plt 40/10 BOTH IP/OP "$2,088.00 " "$1,545.12" $0.00 "$1,670.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,549.71" "$1,549.71" "$1,609.43" $0.00 $435.14 $0.00 $0.00 $0.00 $0.00 "$1,044.00" "$1,653.70" "$1,670.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008667 EAP Custom 27008667 100deg Adoles Osteo Plt 40/10 BOTH IP/OP "$2,219.00 " "$1,642.06" $0.00 "$1,775.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,646.94" "$1,646.94" "$1,710.41" $0.00 $462.44 $0.00 $0.00 $0.00 $0.00 "$1,109.50" "$1,757.45" "$1,775.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008670 EAP Custom 27008670 100deg Adoles Osteo Plt 50/15 BOTH IP/OP "$2,088.00 " "$1,545.12" $0.00 "$1,670.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,549.71" "$1,549.71" "$1,609.43" $0.00 $435.14 $0.00 $0.00 $0.00 $0.00 "$1,044.00" "$1,653.70" "$1,670.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008671 EAP Custom 27008671 100deg Adoles Osteo Plt 50/15 BOTH IP/OP "$2,219.00 " "$1,642.06" $0.00 "$1,775.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,646.94" "$1,646.94" "$1,710.41" $0.00 $462.44 $0.00 $0.00 $0.00 $0.00 "$1,109.50" "$1,757.45" "$1,775.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008674 EAP Custom 27008674 100deg Adoles Osteo Plt 60/15 BOTH IP/OP "$2,088.00 " "$1,545.12" $0.00 "$1,670.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,549.71" "$1,549.71" "$1,609.43" $0.00 $435.14 $0.00 $0.00 $0.00 $0.00 "$1,044.00" "$1,653.70" "$1,670.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008675 EAP Custom 27008675 100deg Adoles Osteo Plt 60/15 BOTH IP/OP "$2,219.00 " "$1,642.06" $0.00 "$1,775.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,646.94" "$1,646.94" "$1,710.41" $0.00 $462.44 $0.00 $0.00 $0.00 $0.00 "$1,109.50" "$1,757.45" "$1,775.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008678 EAP Custom 27008678 100deg Adoles Osteo Plt 40/15 BOTH IP/OP "$2,088.00 " "$1,545.12" $0.00 "$1,670.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,549.71" "$1,549.71" "$1,609.43" $0.00 $435.14 $0.00 $0.00 $0.00 $0.00 "$1,044.00" "$1,653.70" "$1,670.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008679 EAP Custom 27008679 100deg Adoles Osteo Plt 40/15 BOTH IP/OP "$2,219.00 " "$1,642.06" $0.00 "$1,775.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,646.94" "$1,646.94" "$1,710.41" $0.00 $462.44 $0.00 $0.00 $0.00 $0.00 "$1,109.50" "$1,757.45" "$1,775.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008680 EAP Custom 27008680 115 Deg Bifurcatd Plte 30/5 BOTH IP/OP "$1,187.00 " $878.38 $0.00 $949.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $880.99 $880.99 $914.94 $0.00 $247.37 $0.00 $0.00 $0.00 $0.00 $593.50 $940.10 $949.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008681 EAP Custom 27008681 115 Deg Bifurcatd Plte 30/5 BOTH IP/OP "$1,318.00 " $975.32 $0.00 "$1,054.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $978.22 $978.22 "$1,015.91" $0.00 $274.67 $0.00 $0.00 $0.00 $0.00 $659.00 "$1,043.86" "$1,054.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008682 EAP Custom 27008682 115 Deg Bifurcatd Plte 35/5 BOTH IP/OP "$1,187.00 " $878.38 $0.00 $949.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $880.99 $880.99 $914.94 $0.00 $247.37 $0.00 $0.00 $0.00 $0.00 $593.50 $940.10 $949.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27008683 EAP Custom 27008683 115 Deg Bifurcatd Plte 35/5 BOTH IP/OP "$1,318.00 " $975.32 $0.00 "$1,054.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $978.22 $978.22 "$1,015.91" $0.00 $274.67 $0.00 $0.00 $0.00 $0.00 $659.00 "$1,043.86" "$1,054.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27010225 EAP Custom 27010225 0.8mm Guide Wire 100mm BOTH IP/OP $611.00 $452.14 $0.00 $488.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $453.48 $453.48 $470.96 $0.00 $127.33 $0.00 $0.00 $0.00 $0.00 $305.50 $483.91 $488.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27010807 EAP Custom 27010807 "Bipolar Cord,disposable" BOTH IP/OP $683.00 $505.42 $0.00 $546.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $506.92 $506.92 $526.46 $0.00 $142.34 $0.00 $0.00 $0.00 $0.00 $341.50 $540.94 $546.40 $0.00 $443.95 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27010828 EAP Custom 27010828 Cast App'l-spica Adult BOTH IP/OP $749.00 $554.26 $0.00 $599.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $374.50 $593.21 $599.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27010880 EAP Custom 27010880 Colostomy Bag & Supplies BOTH IP/OP $509.00 $376.66 $0.00 $407.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $377.78 $377.78 $392.34 $0.00 $106.08 $0.00 $0.00 $0.00 $0.00 $254.50 $403.13 $407.20 $0.00 $330.85 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27010881 EAP Custom 27010881 Gen-supp-guide Wire BOTH IP/OP $160.00 $118.40 $0.00 $128.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $118.75 $118.75 $123.33 $0.00 $33.34 $0.00 $0.00 $0.00 $0.00 $80.00 $126.72 $128.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27010943 EAP Custom 27010943 Endo Stitch* Polysorb* 3/0 7 V BOTH IP/OP $198.00 $146.52 $0.00 $158.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $146.96 $146.96 $152.62 $0.00 $41.26 $0.00 $0.00 $0.00 $0.00 $99.00 $156.82 $158.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27010987 EAP Custom 27010987 3.2mm Guide Wire 290mm BOTH IP/OP $501.00 $370.74 $0.00 $400.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $371.84 $371.84 $386.17 $0.00 $104.41 $0.00 $0.00 $0.00 $0.00 $250.50 $396.79 $400.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27010993 EAP Custom 27010993 Humeral Fracture Brace BOTH IP/OP $196.00 $145.04 $0.00 $156.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $145.47 $145.47 $151.08 $0.00 $40.85 $0.00 $0.00 $0.00 $0.00 $98.00 $155.23 $156.80 $0.00 $127.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27010994 EAP Custom 27010994 Wound Care Shoe BOTH IP/OP $309.00 $228.66 $0.00 $247.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $229.34 $229.34 $238.18 $0.00 $64.40 $0.00 $0.00 $0.00 $0.00 $154.50 $244.73 $247.20 $0.00 $200.85 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27010997 EAP Custom 27010997 3mmx20cm Tunneler BOTH IP/OP $656.00 $485.44 $0.00 $524.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $486.88 $486.88 $505.64 $0.00 $136.71 $0.00 $0.00 $0.00 $0.00 $328.00 $519.55 $524.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011002 EAP Custom 27011002 4fr Catheter Cobra 2 BOTH IP/OP $166.00 $122.84 $0.00 $132.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $123.21 $123.21 $127.95 $0.00 $34.59 $0.00 $0.00 $0.00 $0.00 $83.00 $131.47 $132.80 $0.00 $107.90 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011008 EAP Custom 27011008 5fr-100cm Sim 1 Cath BOTH IP/OP $60.00 $44.40 $0.00 $48.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $44.53 $44.53 $46.25 $0.00 $12.50 $0.00 $0.00 $0.00 $0.00 $30.00 $47.52 $48.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011009 EAP Custom 27011009 5mmx19cmx90cm Monorail Bilary BOTH IP/OP "$4,654.00 " "$3,443.96" $0.00 "$3,723.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$3,454.20" "$3,454.20" "$3,587.30" $0.00 $969.89 $0.00 $0.00 $0.00 $0.00 "$2,327.00" "$3,685.97" "$3,723.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011010 EAP Custom 27011010 5x135x40cm Unifuse Kit BOTH IP/OP $550.00 $407.00 $0.00 $440.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $408.21 $408.21 $423.94 $0.00 $114.62 $0.00 $0.00 $0.00 $0.00 $275.00 $435.60 $440.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011011 EAP Custom 27011011 5x135x50cm Unifuse Kit BOTH IP/OP $550.00 $407.00 $0.00 $440.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $408.21 $408.21 $423.94 $0.00 $114.62 $0.00 $0.00 $0.00 $0.00 $275.00 $435.60 $440.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011013 EAP Custom 27011013 6fr Al1 Catheter BOTH IP/OP $31.00 $22.94 $0.00 $24.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $23.01 $23.01 $23.89 $0.00 $6.46 $0.00 $0.00 $0.00 $0.00 $15.50 $24.55 $24.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011015 EAP Custom 27011015 6fr Ar1 Catheter BOTH IP/OP $31.00 $22.94 $0.00 $24.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $23.01 $23.01 $23.89 $0.00 $6.46 $0.00 $0.00 $0.00 $0.00 $15.50 $24.55 $24.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011028 EAP Custom 27011028 7.1 Fr 100cm Pigtail Cath BOTH IP/OP $60.00 $44.40 $0.00 $48.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $44.53 $44.53 $46.25 $0.00 $12.50 $0.00 $0.00 $0.00 $0.00 $30.00 $47.52 $48.00 $0.00 $39.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011029 EAP Custom 27011029 8fr X 40cm Skater Biliary Drai BOTH IP/OP $254.00 $187.96 $0.00 $203.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $188.52 $188.52 $195.78 $0.00 $52.93 $0.00 $0.00 $0.00 $0.00 $127.00 $201.17 $203.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011032 EAP Custom 27011032 Air Guard Valved Introducer BOTH IP/OP $335.00 $247.90 $0.00 $268.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $248.64 $248.64 $258.22 $0.00 $69.81 $0.00 $0.00 $0.00 $0.00 $167.50 $265.32 $268.00 $0.00 $217.75 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011033 EAP Custom 27011033 Bag Drainage Ureteral BOTH IP/OP $103.00 $76.22 $0.00 $82.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $76.45 $76.45 $79.39 $0.00 $21.47 $0.00 $0.00 $0.00 $0.00 $51.50 $81.58 $82.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011037 EAP Custom 27011037 Balloon Dial Cath Xxl 12mmx4cm BOTH IP/OP $856.00 $633.44 $0.00 $684.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $635.32 $635.32 $659.80 $0.00 $178.39 $0.00 $0.00 $0.00 $0.00 $428.00 $677.95 $684.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011039 EAP Custom 27011039 Balloon Polar Cath 4x60x120 BOTH IP/OP "$2,002.00 " "$1,481.48" $0.00 "$1,601.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,485.88" "$1,485.88" "$1,543.14" $0.00 $417.22 $0.00 $0.00 $0.00 $0.00 "$1,001.00" "$1,585.58" "$1,601.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011040 EAP Custom 27011040 Balloon Polar Cath 5x40x120 BOTH IP/OP "$2,002.00 " "$1,481.48" $0.00 "$1,601.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,485.88" "$1,485.88" "$1,543.14" $0.00 $417.22 $0.00 $0.00 $0.00 $0.00 "$1,001.00" "$1,585.58" "$1,601.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011041 EAP Custom 27011041 Balloon Polar Cath 5x60x120 BOTH IP/OP "$2,002.00 " "$1,481.48" $0.00 "$1,601.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,485.88" "$1,485.88" "$1,543.14" $0.00 $417.22 $0.00 $0.00 $0.00 $0.00 "$1,001.00" "$1,585.58" "$1,601.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011051 EAP Custom 27011051 Basket Stone Removal 8-wire BOTH IP/OP $963.00 $712.62 $0.00 $770.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $714.74 $714.74 $742.28 $0.00 $200.69 $0.00 $0.00 $0.00 $0.00 $481.50 $762.70 $770.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011052 EAP Custom 27011052 Bead Block 100-300 BOTH IP/OP $667.00 $493.58 $0.00 $533.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $495.05 $495.05 $514.12 $0.00 $139.00 $0.00 $0.00 $0.00 $0.00 $333.50 $528.26 $533.60 $0.00 $433.55 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011053 EAP Custom 27011053 Bead Block 300-500 BOTH IP/OP $667.00 $493.58 $0.00 $533.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $495.05 $495.05 $514.12 $0.00 $139.00 $0.00 $0.00 $0.00 $0.00 $333.50 $528.26 $533.60 $0.00 $433.55 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011054 EAP Custom 27011054 Bead Block 500-700 BOTH IP/OP $667.00 $493.58 $0.00 $533.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $495.05 $495.05 $514.12 $0.00 $139.00 $0.00 $0.00 $0.00 $0.00 $333.50 $528.26 $533.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011055 EAP Custom 27011055 Bead Block 700-900 BOTH IP/OP $667.00 $493.58 $0.00 $533.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $495.05 $495.05 $514.12 $0.00 $139.00 $0.00 $0.00 $0.00 $0.00 $333.50 $528.26 $533.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011056 EAP Custom 27011056 Bead Block 900-1200 BOTH IP/OP $667.00 $493.58 $0.00 $533.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $495.05 $495.05 $514.12 $0.00 $139.00 $0.00 $0.00 $0.00 $0.00 $333.50 $528.26 $533.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011058 EAP Custom 27011058 Cath 20fr 24cm Tenacath Hsg BOTH IP/OP $157.00 $116.18 $0.00 $125.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $78.50 $124.34 $125.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011061 EAP Custom 27011061 Cath 5fr 100cm Berenstein BOTH IP/OP $35.00 $25.90 $0.00 $28.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $25.98 $25.98 $26.98 $0.00 $7.29 $0.00 $0.00 $0.00 $0.00 $17.50 $27.72 $28.00 $0.00 $22.75 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011062 EAP Custom 27011062 Cath 5fr 100cm Sim2 BOTH IP/OP $61.00 $45.14 $0.00 $48.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $30.50 $48.31 $48.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011063 EAP Custom 27011063 Cath 5fr 100cm Sim3 BOTH IP/OP $35.00 $25.90 $0.00 $28.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $17.50 $27.72 $28.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011065 EAP Custom 27011065 Cath 5fr 40cm Berenstein BOTH IP/OP $40.00 $29.60 $0.00 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $29.69 $29.69 $30.83 $0.00 $8.34 $0.00 $0.00 $0.00 $0.00 $20.00 $31.68 $32.00 $0.00 $26.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011067 EAP Custom 27011067 Cath 5fr 65cm Berenstein BOTH IP/OP $40.00 $29.60 $0.00 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $29.69 $29.69 $30.83 $0.00 $8.34 $0.00 $0.00 $0.00 $0.00 $20.00 $31.68 $32.00 $0.00 $26.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011068 EAP Custom 27011068 Cath 5fr 65cm Cobra1 BOTH IP/OP $35.00 $25.90 $0.00 $28.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $25.98 $25.98 $26.98 $0.00 $7.29 $0.00 $0.00 $0.00 $0.00 $17.50 $27.72 $28.00 $0.00 $22.75 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011069 EAP Custom 27011069 Cath 5fr 65cm Cobra2 BOTH IP/OP $35.00 $25.90 $0.00 $28.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $25.98 $25.98 $26.98 $0.00 $7.29 $0.00 $0.00 $0.00 $0.00 $17.50 $27.72 $28.00 $0.00 $22.75 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011070 EAP Custom 27011070 Cath 5fr 65cm Ns Straight BOTH IP/OP $60.00 $44.40 $0.00 $48.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $44.53 $44.53 $46.25 $0.00 $12.50 $0.00 $0.00 $0.00 $0.00 $30.00 $47.52 $48.00 $0.00 $39.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011071 EAP Custom 27011071 Cath 5fr 65cm Pig BOTH IP/OP $40.00 $29.60 $0.00 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $29.69 $29.69 $30.83 $0.00 $8.34 $0.00 $0.00 $0.00 $0.00 $20.00 $31.68 $32.00 $0.00 $26.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011073 EAP Custom 27011073 Cath 5fr 80 Cm Mikalesson BOTH IP/OP $35.00 $25.90 $0.00 $28.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $25.98 $25.98 $26.98 $0.00 $7.29 $0.00 $0.00 $0.00 $0.00 $17.50 $27.72 $28.00 $0.00 $22.75 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011074 EAP Custom 27011074 Cath 5fr 80cm Sos1 BOTH IP/OP $166.00 $122.84 $0.00 $132.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $123.21 $123.21 $127.95 $0.00 $34.59 $0.00 $0.00 $0.00 $0.00 $83.00 $131.47 $132.80 $0.00 $107.90 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011075 EAP Custom 27011075 Cath 5fr 80cm Sos2 BOTH IP/OP $35.00 $25.90 $0.00 $28.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $25.98 $25.98 $26.98 $0.00 $7.29 $0.00 $0.00 $0.00 $0.00 $17.50 $27.72 $28.00 $0.00 $22.75 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011077 EAP Custom 27011077 Cath Polar Dilator Bal4x80x120 BOTH IP/OP "$2,335.00 " "$1,727.90" $0.00 "$1,868.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,167.50" "$1,849.32" "$1,868.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011078 EAP Custom 27011078 Cath Polar Dilator Bal5x80x120 BOTH IP/OP "$2,002.00 " "$1,481.48" $0.00 "$1,601.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,001.00" "$1,585.58" "$1,601.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011083 EAP Custom 27011083 Cath Triple Lumen 11fr BOTH IP/OP $413.00 $305.62 $0.00 $330.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $206.50 $327.10 $330.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011084 EAP Custom 27011084 Catheter Repair Kit BOTH IP/OP $349.00 $258.26 $0.00 $279.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $259.03 $259.03 $269.01 $0.00 $72.73 $0.00 $0.00 $0.00 $0.00 $174.50 $276.41 $279.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011086 EAP Custom 27011086 Chest Unit Drainage Pleur BOTH IP/OP $469.00 $347.06 $0.00 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $348.09 $348.09 $361.51 $0.00 $97.74 $0.00 $0.00 $0.00 $0.00 $234.50 $371.45 $375.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011088 EAP Custom 27011088 Coil 15-250 Micron (2vl/bx) BOTH IP/OP $477.00 $352.98 $0.00 $381.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $354.03 $354.03 $367.67 $0.00 $99.41 $0.00 $0.00 $0.00 $0.00 $238.50 $377.78 $381.60 $0.00 $310.05 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011089 EAP Custom 27011089 Coil 250-355 Micron (5vl/bx) BOTH IP/OP $463.00 $342.62 $0.00 $370.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $343.64 $343.64 $356.88 $0.00 $96.49 $0.00 $0.00 $0.00 $0.00 $231.50 $366.70 $370.40 $0.00 $300.95 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011090 EAP Custom 27011090 Coil 355-500 Micron (5vl/bx) BOTH IP/OP $384.00 $284.16 $0.00 $307.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $285.00 $285.00 $295.99 $0.00 $80.03 $0.00 $0.00 $0.00 $0.00 $192.00 $304.13 $307.20 $0.00 $249.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011091 EAP Custom 27011091 Coil 500-710 Micron (2vl/bx) BOTH IP/OP $477.00 $352.98 $0.00 $381.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $238.50 $377.78 $381.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011092 EAP Custom 27011092 Coil 710-1000 Micron (2vl/bx) BOTH IP/OP $477.00 $352.98 $0.00 $381.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $238.50 $377.78 $381.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011093 EAP Custom 27011093 Coil Pusher 16 BOTH IP/OP $544.00 $402.56 $0.00 $435.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $403.76 $403.76 $419.32 $0.00 $113.37 $0.00 $0.00 $0.00 $0.00 $272.00 $430.85 $435.20 $0.00 $353.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011094 EAP Custom 27011094 Coil Pusher Trupush BOTH IP/OP "$1,228.00 " $908.72 $0.00 $982.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $911.42 $911.42 $946.54 $0.00 $255.92 $0.00 $0.00 $0.00 $0.00 $614.00 $972.58 $982.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011095 EAP Custom 27011095 Connector Ureteral Catheter BOTH IP/OP $15.00 $11.10 $0.00 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.13 $11.13 $11.56 $0.00 $3.13 $0.00 $0.00 $0.00 $0.00 $7.50 $11.88 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011096 EAP Custom 27011096 Connectory Tuohy BOTH IP/OP $90.00 $66.60 $0.00 $72.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $66.80 $66.80 $69.37 $0.00 $18.76 $0.00 $0.00 $0.00 $0.00 $45.00 $71.28 $72.00 $0.00 $58.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011097 EAP Custom 27011097 Contra 2 BOTH IP/OP $40.00 $29.60 $0.00 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $29.69 $29.69 $30.83 $0.00 $8.34 $0.00 $0.00 $0.00 $0.00 $20.00 $31.68 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011098 EAP Custom 27011098 Contra Flush Catheter BOTH IP/OP $199.00 $147.26 $0.00 $159.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $147.70 $147.70 $153.39 $0.00 $41.47 $0.00 $0.00 $0.00 $0.00 $99.50 $157.61 $159.20 $0.00 $129.35 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011099 EAP Custom 27011099 Cope Suture Anchor Set BOTH IP/OP $199.00 $147.26 $0.00 $159.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $147.70 $147.70 $153.39 $0.00 $41.47 $0.00 $0.00 $0.00 $0.00 $99.50 $157.61 $159.20 $0.00 $129.35 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011105 EAP Custom 27011105 Embolization 38-4-3 BOTH IP/OP $194.00 $143.56 $0.00 $155.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $143.99 $143.99 $149.54 $0.00 $40.43 $0.00 $0.00 $0.00 $0.00 $97.00 $153.65 $155.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011106 EAP Custom 27011106 Embolization 38-8-15 BOTH IP/OP $194.00 $143.56 $0.00 $155.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $143.99 $143.99 $149.54 $0.00 $40.43 $0.00 $0.00 $0.00 $0.00 $97.00 $153.65 $155.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011107 EAP Custom 27011107 Embolization Coil 38-5-5 BOTH IP/OP $194.00 $143.56 $0.00 $155.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $143.99 $143.99 $149.54 $0.00 $40.43 $0.00 $0.00 $0.00 $0.00 $97.00 $153.65 $155.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011108 EAP Custom 27011108 Embolization Coils 38-2-3 BOTH IP/OP $194.00 $143.56 $0.00 $155.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $143.99 $143.99 $149.54 $0.00 $40.43 $0.00 $0.00 $0.00 $0.00 $97.00 $153.65 $155.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011109 EAP Custom 27011109 Embolization Coils 38-4-2 BOTH IP/OP $194.00 $143.56 $0.00 $155.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $143.99 $143.99 $149.54 $0.00 $40.43 $0.00 $0.00 $0.00 $0.00 $97.00 $153.65 $155.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011110 EAP Custom 27011110 Embolization Coils 38-5-10 BOTH IP/OP $194.00 $143.56 $0.00 $155.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $143.99 $143.99 $149.54 $0.00 $40.43 $0.00 $0.00 $0.00 $0.00 $97.00 $153.65 $155.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011111 EAP Custom 27011111 Face Shields BOTH IP/OP $14.00 $10.36 $0.00 $11.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $10.39 $10.39 $10.79 $0.00 $2.92 $0.00 $0.00 $0.00 $0.00 $7.00 $11.09 $11.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011112 EAP Custom 27011112 Filling Station Plus (neuro) BOTH IP/OP $94.00 $69.56 $0.00 $75.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $69.77 $69.77 $72.46 $0.00 $19.59 $0.00 $0.00 $0.00 $0.00 $47.00 $74.45 $75.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011113 EAP Custom 27011113 Filter Jugular G-2 BOTH IP/OP "$4,337.00 " "$3,209.38" $0.00 "$3,469.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$3,218.92" "$3,218.92" "$3,342.96" $0.00 $903.83 $0.00 $0.00 $0.00 $0.00 "$2,168.50" "$3,434.90" "$3,469.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011114 EAP Custom 27011114 Flo-switch Hp BOTH IP/OP $380.00 $281.20 $0.00 $304.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $282.04 $282.04 $292.90 $0.00 $79.19 $0.00 $0.00 $0.00 $0.00 $190.00 $300.96 $304.00 $0.00 $247.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011120 EAP Custom 27011120 Forearm Based Outrigger BOTH IP/OP $172.00 $127.28 $0.00 $137.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $127.66 $127.66 $132.58 $0.00 $35.84 $0.00 $0.00 $0.00 $0.00 $86.00 $136.22 $137.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011121 EAP Custom 27011121 Gtgw.180cm-45deg Angle BOTH IP/OP $501.00 $370.74 $0.00 $400.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $371.84 $371.84 $386.17 $0.00 $104.41 $0.00 $0.00 $0.00 $0.00 $250.50 $396.79 $400.80 $0.00 $325.65 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011122 EAP Custom 27011122 Hemostasis V-pad BOTH IP/OP $160.00 $118.40 $0.00 $128.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $118.75 $118.75 $123.33 $0.00 $33.34 $0.00 $0.00 $0.00 $0.00 $80.00 $126.72 $128.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011124 EAP Custom 27011124 Igtcfs-65-fem Celect Perm Cook BOTH IP/OP "$4,005.00 " "$2,963.70" $0.00 "$3,204.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,972.51" "$2,972.51" "$3,087.05" $0.00 $834.64 $0.00 $0.00 $0.00 $0.00 "$2,002.50" "$3,171.96" "$3,204.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011125 EAP HCPCS C1880 Igtcfs-65-jugcelet Perm Cook BOTH IP/OP "$4,536.00 " "$3,356.64" $0.00 "$3,628.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,268.00" "$3,592.51" "$3,628.80" $0.00 $0.00 $0.00 $709.88 $0.00 $0.00 $722.13 $0.00 $0.00 $0.00 $0.00 $0.00 27011126 EAP Custom 27011126 Inflation Device Monarch-25 BOTH IP/OP $184.00 $136.16 $0.00 $147.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $38.35 $0.00 $0.00 $0.00 $0.00 $92.00 $145.73 $147.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011127 EAP Custom 27011127 Introducer Mpis-401 BOTH IP/OP $94.00 $69.56 $0.00 $75.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $69.77 $69.77 $72.46 $0.00 $19.59 $0.00 $0.00 $0.00 $0.00 $47.00 $74.45 $75.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011128 EAP Custom 27011128 Introducer Pinnacle 5fr 10cm BOTH IP/OP $67.00 $49.58 $0.00 $53.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $49.73 $49.73 $51.64 $0.00 $13.96 $0.00 $0.00 $0.00 $0.00 $33.50 $53.06 $53.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011129 EAP Custom 27011129 Jcd 10.0-38-20 BOTH IP/OP $42.00 $31.08 $0.00 $33.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $31.17 $31.17 $32.37 $0.00 $8.75 $0.00 $0.00 $0.00 $0.00 $21.00 $33.26 $33.60 $0.00 $27.30 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011130 EAP Custom 27011130 Jcd 12.0-38-20 BOTH IP/OP $44.00 $32.56 $0.00 $35.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $32.66 $32.66 $33.92 $0.00 $9.17 $0.00 $0.00 $0.00 $0.00 $22.00 $34.85 $35.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011131 EAP Custom 27011131 Jcd 14.0-38-20 BOTH IP/OP $51.00 $37.74 $0.00 $40.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $37.85 $37.85 $39.31 $0.00 $10.63 $0.00 $0.00 $0.00 $0.00 $25.50 $40.39 $40.80 $0.00 $33.15 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011132 EAP Custom 27011132 Jcd 16.0-38-20 BOTH IP/OP $51.00 $37.74 $0.00 $40.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $37.85 $37.85 $39.31 $0.00 $10.63 $0.00 $0.00 $0.00 $0.00 $25.50 $40.39 $40.80 $0.00 $33.15 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011133 EAP Custom 27011133 Jcd 4.0-25-20 BOTH IP/OP $31.00 $22.94 $0.00 $24.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $23.01 $23.01 $23.89 $0.00 $6.46 $0.00 $0.00 $0.00 $0.00 $15.50 $24.55 $24.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011134 EAP Custom 27011134 Jcd 5.0-38-20 BOTH IP/OP $17.00 $12.58 $0.00 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $12.62 $12.62 $13.10 $0.00 $3.54 $0.00 $0.00 $0.00 $0.00 $8.50 $13.46 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011135 EAP Custom 27011135 Jcd 6.0-38-20 BOTH IP/OP $42.00 $31.08 $0.00 $33.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $31.17 $31.17 $32.37 $0.00 $8.75 $0.00 $0.00 $0.00 $0.00 $21.00 $33.26 $33.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011136 EAP Custom 27011136 Jcd 7.0-38-20 BOTH IP/OP $17.00 $12.58 $0.00 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $12.62 $12.62 $13.10 $0.00 $3.54 $0.00 $0.00 $0.00 $0.00 $8.50 $13.46 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011137 EAP Custom 27011137 Jcd 8.0-38-20 BOTH IP/OP $17.00 $12.58 $0.00 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $12.62 $12.62 $13.10 $0.00 $3.54 $0.00 $0.00 $0.00 $0.00 $8.50 $13.46 $13.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011138 EAP Custom 27011138 Jcd 9.0-38-20 BOTH IP/OP $42.00 $31.08 $0.00 $33.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $31.17 $31.17 $32.37 $0.00 $8.75 $0.00 $0.00 $0.00 $0.00 $21.00 $33.26 $33.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011139 EAP Custom 27011139 Jcd-20.0-38-20 Dilator BOTH IP/OP $36.00 $26.64 $0.00 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $26.72 $26.72 $27.75 $0.00 $7.50 $0.00 $0.00 $0.00 $0.00 $18.00 $28.51 $28.80 $0.00 $23.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011140 EAP Custom 27011140 Jcd-22.0-38-20 Dilator BOTH IP/OP $45.00 $33.30 $0.00 $36.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $33.40 $33.40 $34.69 $0.00 $9.38 $0.00 $0.00 $0.00 $0.00 $22.50 $35.64 $36.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011141 EAP Custom 27011141 Jcd-24.0-38-20 Dilator BOTH IP/OP $45.00 $33.30 $0.00 $36.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $33.40 $33.40 $34.69 $0.00 $9.38 $0.00 $0.00 $0.00 $0.00 $22.50 $35.64 $36.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011142 EAP Custom 27011142 Jcd-d18.0-38-20 Dilator BOTH IP/OP $51.00 $37.74 $0.00 $40.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $37.85 $37.85 $39.31 $0.00 $10.63 $0.00 $0.00 $0.00 $0.00 $25.50 $40.39 $40.80 $0.00 $33.15 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011143 EAP Custom 27011143 Kinair Iii W/o Scale BOTH IP/OP $192.00 $142.08 $0.00 $153.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $142.50 $142.50 $147.99 $0.00 $40.01 $0.00 $0.00 $0.00 $0.00 $96.00 $152.06 $153.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011148 EAP Custom 27011148 Kit Angio Saftey With J Wire BOTH IP/OP $178.00 $131.72 $0.00 $142.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $132.11 $132.11 $137.20 $0.00 $37.10 $0.00 $0.00 $0.00 $0.00 $89.00 $140.98 $142.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011149 EAP Custom 27011149 Kit Fallopian Tube BOTH IP/OP $349.00 $258.26 $0.00 $279.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $259.03 $259.03 $269.01 $0.00 $72.73 $0.00 $0.00 $0.00 $0.00 $174.50 $276.41 $279.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011150 EAP Custom 27011150 Kit Gastrostomy 18fr BOTH IP/OP $541.00 $400.34 $0.00 $432.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $401.53 $401.53 $417.00 $0.00 $112.74 $0.00 $0.00 $0.00 $0.00 $270.50 $428.47 $432.80 $0.00 $351.65 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011151 EAP Custom 27011151 Kit Mahurkar 12f Triple Lumen BOTH IP/OP $300.00 $222.00 $0.00 $240.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $222.66 $222.66 $231.24 $0.00 $62.52 $0.00 $0.00 $0.00 $0.00 $150.00 $237.60 $240.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011152 EAP Custom 27011152 Kit Pressure Monitoring T BOTH IP/OP $71.00 $52.54 $0.00 $56.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $52.70 $52.70 $54.73 $0.00 $14.80 $0.00 $0.00 $0.00 $0.00 $35.50 $56.23 $56.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011153 EAP Custom 27011153 Kit Pressure Monitoring T BOTH IP/OP $163.00 $120.62 $0.00 $130.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $120.98 $120.98 $125.64 $0.00 $33.97 $0.00 $0.00 $0.00 $0.00 $81.50 $129.10 $130.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011154 EAP Custom 27011154 Kit Triple Lumen Catheter BOTH IP/OP $726.00 $537.24 $0.00 $580.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $538.84 $538.84 $559.60 $0.00 $151.30 $0.00 $0.00 $0.00 $0.00 $363.00 $574.99 $580.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011156 EAP Custom 27011156 Lancet Grady Orange BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011157 EAP Custom 27011157 Line Connecting 36 Hp BOTH IP/OP $69.00 $51.06 $0.00 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $51.21 $51.21 $53.19 $0.00 $14.38 $0.00 $0.00 $0.00 $0.00 $34.50 $54.65 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011158 EAP Custom 27011158 Line Connecting 48 Hp BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011160 EAP Custom 27011160 Mask Sub-micron Small BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011161 EAP Custom 27011161 Med/surg Semi Supplies BOTH IP/OP $64.00 $47.36 $0.00 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $47.50 $47.50 $49.33 $0.00 $13.34 $0.00 $0.00 $0.00 $0.00 $32.00 $50.69 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011162 EAP Custom 27011162 Microsphere Embogold 500-700 BOTH IP/OP $734.00 $543.16 $0.00 $587.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $544.77 $544.77 $565.77 $0.00 $152.97 $0.00 $0.00 $0.00 $0.00 $367.00 $581.33 $587.20 $0.00 $477.10 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011163 EAP Custom 27011163 Microsphere Embogold 700-900 BOTH IP/OP $734.00 $543.16 $0.00 $587.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $544.77 $544.77 $565.77 $0.00 $152.97 $0.00 $0.00 $0.00 $0.00 $367.00 $581.33 $587.20 $0.00 $477.10 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011164 EAP Custom 27011164 Microsphere Embogold 900-1200 BOTH IP/OP "$3,669.00 " "$2,715.06" $0.00 "$2,935.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,834.50" "$2,905.85" "$2,935.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011165 EAP Custom 27011165 Needle Chiba 22ga X 15cm BOTH IP/OP $82.00 $60.68 $0.00 $65.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $60.86 $60.86 $63.21 $0.00 $17.09 $0.00 $0.00 $0.00 $0.00 $41.00 $64.94 $65.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011166 EAP Custom 27011166 Needle Hypodermic Sterile BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011167 EAP Custom 27011167 Needle Hypodermic Sterile BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011168 EAP Custom 27011168 Needle Port-cath 20ga X 1 BOTH IP/OP $34.00 $25.16 $0.00 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $25.23 $25.23 $26.21 $0.00 $7.09 $0.00 $0.00 $0.00 $0.00 $17.00 $26.93 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011169 EAP Custom 27011169 Needle Port-cath 20ga X 1 BOTH IP/OP $34.00 $25.16 $0.00 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $25.23 $25.23 $26.21 $0.00 $7.09 $0.00 $0.00 $0.00 $0.00 $17.00 $26.93 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011172 EAP Custom 27011172 Olcott Torque Device BOTH IP/OP $65.00 $48.10 $0.00 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $48.24 $48.24 $50.10 $0.00 $13.55 $0.00 $0.00 $0.00 $0.00 $32.50 $51.48 $52.00 $0.00 $42.25 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011176 EAP Custom 27011176 Perc Gastrostomy Set BOTH IP/OP "$1,079.00 " $798.46 $0.00 $863.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $800.83 $800.83 $831.69 $0.00 $224.86 $0.00 $0.00 $0.00 $0.00 $539.50 $854.57 $863.20 $0.00 $701.35 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011177 EAP Custom 27011177 Polar Cath Inflation Unit BOTH IP/OP "$7,912.00 " "$5,854.88" $0.00 "$6,329.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$6,098.57" $0.00 "$1,648.86" $0.00 $0.00 $0.00 $0.00 "$3,956.00" "$6,266.30" "$6,329.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011178 EAP Custom 27011178 Port Peritoneal/drain/ascites BOTH IP/OP "$1,070.00 " $791.80 $0.00 $856.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $794.15 $794.15 $824.76 $0.00 $222.99 $0.00 $0.00 $0.00 $0.00 $535.00 $847.44 $856.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011179 EAP Custom 27011179 Pressure Tubing BOTH IP/OP $555.00 $410.70 $0.00 $444.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $411.92 $411.92 $427.79 $0.00 $115.66 $0.00 $0.00 $0.00 $0.00 $277.50 $439.56 $444.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011181 EAP Custom 27011181 Rapad Shield BOTH IP/OP $131.00 $96.94 $0.00 $104.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $65.50 $103.75 $104.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011182 EAP Custom 27011182 Recovery Cone Removal System BOTH IP/OP "$1,985.00 " "$1,468.90" $0.00 "$1,588.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,473.27" "$1,473.27" "$1,530.04" $0.00 $413.67 $0.00 $0.00 $0.00 $0.00 $992.50 "$1,572.12" "$1,588.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011183 EAP Custom 27011183 Retention Device 10fr BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011184 EAP Custom 27011184 Retention Device 12fr BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011185 EAP Custom 27011185 Retention Device 8fr BOTH IP/OP $40.00 $29.60 $0.00 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $29.69 $29.69 $30.83 $0.00 $8.34 $0.00 $0.00 $0.00 $0.00 $20.00 $31.68 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011190 EAP Custom 27011190 Ring Transjugular Set BOTH IP/OP "$1,404.00 " "$1,038.96" $0.00 "$1,123.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,042.05" "$1,042.05" "$1,082.20" $0.00 $292.59 $0.00 $0.00 $0.00 $0.00 $702.00 "$1,111.97" "$1,123.20" $0.00 $912.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011194 EAP Custom 27011194 Safety Angio Kit BOTH IP/OP $127.00 $93.98 $0.00 $101.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $94.26 $94.26 $97.89 $0.00 $26.47 $0.00 $0.00 $0.00 $0.00 $63.50 $100.58 $101.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011195 EAP Custom 27011195 Safety Peg Kit Moni Bolster BOTH IP/OP "$1,497.00 " "$1,107.78" $0.00 "$1,197.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,111.07" "$1,111.07" "$1,153.89" $0.00 $311.97 $0.00 $0.00 $0.00 $0.00 $748.50 "$1,185.62" "$1,197.60" $0.00 $973.05 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011196 EAP Custom 27011196 Scaple Surg W/handle Attached BOTH IP/OP $16.00 $11.84 $0.00 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.88 $11.88 $12.33 $0.00 $3.33 $0.00 $0.00 $0.00 $0.00 $8.00 $12.67 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011197 EAP Custom 27011197 Set Blood Administration BOTH IP/OP $34.00 $25.16 $0.00 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $25.23 $25.23 $26.21 $0.00 $7.09 $0.00 $0.00 $0.00 $0.00 $17.00 $26.93 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011198 EAP Custom 27011198 Set Blood Adminstration BOTH IP/OP $69.00 $51.06 $0.00 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $51.21 $51.21 $53.19 $0.00 $14.38 $0.00 $0.00 $0.00 $0.00 $34.50 $54.65 $55.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011199 EAP Custom 27011199 Set Blood Adminstration BOTH IP/OP $65.00 $48.10 $0.00 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $48.24 $48.24 $50.10 $0.00 $13.55 $0.00 $0.00 $0.00 $0.00 $32.50 $51.48 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011200 EAP Custom 27011200 Set Liver Biopsy Labs-100 BOTH IP/OP "$1,409.00 " "$1,042.66" $0.00 "$1,127.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,045.76" "$1,045.76" "$1,086.06" $0.00 $293.64 $0.00 $0.00 $0.00 $0.00 $704.50 "$1,115.93" "$1,127.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011201 EAP Custom 27011201 Set Mediport Infusion W/i BOTH IP/OP $36.00 $26.64 $0.00 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $26.72 $26.72 $27.75 $0.00 $7.50 $0.00 $0.00 $0.00 $0.00 $18.00 $28.51 $28.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011202 EAP Custom 27011202 Set Neff Perc Access BOTH IP/OP $244.00 $180.56 $0.00 $195.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $181.10 $181.10 $188.08 $0.00 $50.85 $0.00 $0.00 $0.00 $0.00 $122.00 $193.25 $195.20 $0.00 $158.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011203 EAP Custom 27011203 Set Pca Mini-bore W/int A BOTH IP/OP $44.00 $32.56 $0.00 $35.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $32.66 $32.66 $33.92 $0.00 $9.17 $0.00 $0.00 $0.00 $0.00 $22.00 $34.85 $35.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011204 EAP Custom 27011204 Set Scalp Vein Infusion 21 G BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011207 EAP Custom 27011207 Set Scalp Vein Infusion 2 BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011208 EAP Custom 27011208 Set Secondary Piggy Back BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011209 EAP Custom 27011209 Set Urinary Drain W/conta BOTH IP/OP $20.00 $14.80 $0.00 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.84 $14.84 $15.42 $0.00 $4.17 $0.00 $0.00 $0.00 $0.00 $10.00 $15.84 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011212 EAP Custom 27011212 Simon-nitinol Vena Cava Filte BOTH IP/OP "$3,605.00 " "$2,667.70" $0.00 "$2,884.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,675.63" "$2,675.63" "$2,778.73" $0.00 $751.28 $0.00 $0.00 $0.00 $0.00 "$1,802.50" "$2,855.16" "$2,884.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011213 EAP Custom 27011213 Simon-nitinol Vena Filter An BOTH IP/OP "$3,085.00 " "$2,282.90" $0.00 "$2,468.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,289.69" "$2,289.69" "$2,377.92" $0.00 $642.91 $0.00 $0.00 $0.00 $0.00 "$1,542.50" "$2,443.32" "$2,468.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011214 EAP Custom 27011214 Skater Introducer System BOTH IP/OP $254.00 $187.96 $0.00 $203.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $188.52 $188.52 $195.78 $0.00 $52.93 $0.00 $0.00 $0.00 $0.00 $127.00 $201.17 $203.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011215 EAP HCPCS C1729 Skater Nephro Cath 8fr X 35cm BOTH IP/OP $288.00 $213.12 $0.00 $230.40 $156.38 $156.38 $0.00 $0.00 $0.00 $60.03 $213.75 $213.75 $221.99 $0.00 $60.02 $0.00 $170.35 $170.35 $0.00 $144.00 $228.10 $230.40 $0.00 $187.20 $0.00 $45.07 $0.00 $0.00 $45.85 $0.00 $0.00 $0.00 $0.00 $0.00 27011216 EAP Custom 27011216 Snare Amplatz 10mm BOTH IP/OP $916.00 $677.84 $0.00 $732.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $679.86 $679.86 $706.05 $0.00 $190.89 $0.00 $0.00 $0.00 $0.00 $458.00 $725.47 $732.80 $0.00 $595.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011217 EAP Custom 27011217 Snare Amplatz 5mm BOTH IP/OP $916.00 $677.84 $0.00 $732.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $679.86 $679.86 $706.05 $0.00 $190.89 $0.00 $0.00 $0.00 $0.00 $458.00 $725.47 $732.80 $0.00 $595.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011226 EAP Custom 27011226 Sponge Gelfoam Gelatin BOTH IP/OP $85.00 $62.90 $0.00 $68.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $63.09 $63.09 $65.52 $0.00 $17.71 $0.00 $0.00 $0.00 $0.00 $42.50 $67.32 $68.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011227 EAP HCPCS C1876 Stent Vascular Covera Covered 10mm X 60mm 80cm Delivery BOTH IP/OP "$6,750.00 " "$4,995.00" $0.00 "$5,400.00" "$3,037.50" "$3,037.50" $0.00 $0.00 $0.00 "$1,406.87" "$4,181.12" "$4,181.12" "$5,202.90" $0.00 "$1,406.70" $0.00 "$3,327.75" "$3,327.75" $0.00 "$3,375.00" "$5,346.00" "$5,400.00" $0.00 $0.00 $0.00 "$1,056.38" $0.00 $0.00 "$1,074.60" $0.00 $0.00 $0.00 $0.00 $0.00 27011228 EAP Custom 27011228 Stent Luminex 12x60 BOTH IP/OP "$3,986.00 " "$2,949.64" $0.00 "$3,188.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,958.41" "$2,958.41" "$3,072.41" $0.00 $830.68 $0.00 $0.00 $0.00 $0.00 "$1,993.00" "$3,156.91" "$3,188.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011229 EAP Custom 27011229 Stent Luminexx 7x30 BOTH IP/OP "$3,986.00 " "$2,949.64" $0.00 "$3,188.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,958.41" "$2,958.41" "$3,072.41" $0.00 $830.68 $0.00 $0.00 $0.00 $0.00 "$1,993.00" "$3,156.91" "$3,188.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011230 EAP Custom 27011230 Stent Luminexx 7x40 BOTH IP/OP "$3,986.00 " "$2,949.64" $0.00 "$3,188.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,958.41" "$2,958.41" "$3,072.41" $0.00 $830.68 $0.00 $0.00 $0.00 $0.00 "$1,993.00" "$3,156.91" "$3,188.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011231 EAP Custom 27011231 Stent Luminexx 8x40 BOTH IP/OP "$3,986.00 " "$2,949.64" $0.00 "$3,188.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,958.41" "$2,958.41" "$3,072.41" $0.00 $830.68 $0.00 $0.00 $0.00 $0.00 "$1,993.00" "$3,156.91" "$3,188.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011232 EAP Custom 27011232 Stent Luminexx Stent 8x30 BOTH IP/OP "$3,986.00 " "$2,949.64" $0.00 "$3,188.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,958.41" "$2,958.41" "$3,072.41" $0.00 $830.68 $0.00 $0.00 $0.00 $0.00 "$1,993.00" "$3,156.91" "$3,188.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011233 EAP Custom 27011233 Stiff Micropunture 5fr BOTH IP/OP $153.00 $113.22 $0.00 $122.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $76.50 $121.18 $122.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011234 EAP Custom 27011234 Stopcock 1-way Hp BOTH IP/OP $14.00 $10.36 $0.00 $11.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $10.39 $10.39 $10.79 $0.00 $2.92 $0.00 $0.00 $0.00 $0.00 $7.00 $11.09 $11.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011236 EAP Custom 27011236 Stopcock 3-way Hp BOTH IP/OP $20.00 $14.80 $0.00 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.84 $14.84 $15.42 $0.00 $4.17 $0.00 $0.00 $0.00 $0.00 $10.00 $15.84 $16.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011237 EAP Custom 27011237 "Supplies, Non-sterile Penumbra" BOTH IP/OP $66.00 $48.84 $0.00 $52.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $48.99 $48.99 $50.87 $0.00 $13.75 $0.00 $0.00 $0.00 $0.00 $33.00 $52.27 $52.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011241 EAP Custom 27011241 Threapulse Ii BOTH IP/OP $581.00 $429.94 $0.00 $464.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $431.22 $431.22 $447.83 $0.00 $121.08 $0.00 $0.00 $0.00 $0.00 $290.50 $460.15 $464.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011242 EAP Custom 27011242 Tray Catheter Urethral 14 BOTH IP/OP $16.00 $11.84 $0.00 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.88 $11.88 $12.33 $0.00 $3.33 $0.00 $0.00 $0.00 $0.00 $8.00 $12.67 $12.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011243 EAP Custom 27011243 Tray Foley Perconnected 1 BOTH IP/OP $52.00 $38.48 $0.00 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $38.59 $38.59 $40.08 $0.00 $10.84 $0.00 $0.00 $0.00 $0.00 $26.00 $41.18 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011244 EAP Custom 27011244 Tray Foley Perconnected 1 BOTH IP/OP $60.00 $44.40 $0.00 $48.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $44.53 $44.53 $46.25 $0.00 $12.50 $0.00 $0.00 $0.00 $0.00 $30.00 $47.52 $48.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011245 EAP Custom 27011245 Tray Foley Preconnected 1 BOTH IP/OP $52.00 $38.48 $0.00 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $38.59 $38.59 $40.08 $0.00 $10.84 $0.00 $0.00 $0.00 $0.00 $26.00 $41.18 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011246 EAP Custom 27011246 Tray Foley Preconnected 1 BOTH IP/OP $60.00 $44.40 $0.00 $48.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $44.53 $44.53 $46.25 $0.00 $12.50 $0.00 $0.00 $0.00 $0.00 $30.00 $47.52 $48.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011252 EAP Custom 27011252 Triple Lumen Catheter Size 24 BOTH IP/OP $250.00 $185.00 $0.00 $200.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $185.55 $185.55 $192.70 $0.00 $52.10 $0.00 $0.00 $0.00 $0.00 $125.00 $198.00 $200.00 $0.00 $162.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011253 EAP Custom 27011253 Tube Feeding Ng 8fr 43in En BOTH IP/OP $68.00 $50.32 $0.00 $54.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $50.47 $50.47 $52.41 $0.00 $14.17 $0.00 $0.00 $0.00 $0.00 $34.00 $53.86 $54.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011254 EAP Custom 27011254 Tube Feeding Ng 8fr 36in Entr BOTH IP/OP $64.00 $47.36 $0.00 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $47.50 $47.50 $49.33 $0.00 $13.34 $0.00 $0.00 $0.00 $0.00 $32.00 $50.69 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011255 EAP Custom 27011255 Tube Gastrostomy 18fr BOTH IP/OP $80.00 $59.20 $0.00 $64.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $59.38 $59.38 $61.66 $0.00 $16.67 $0.00 $0.00 $0.00 $0.00 $40.00 $63.36 $64.00 $0.00 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011256 EAP Custom 27011256 Tube Gastrostomy 22fr BOTH IP/OP $76.00 $56.24 $0.00 $60.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $56.41 $56.41 $58.58 $0.00 $15.84 $0.00 $0.00 $0.00 $0.00 $38.00 $60.19 $60.80 $0.00 $49.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011257 EAP Custom 27011257 Tube Jejunal Feeding 18 Fr O.d BOTH IP/OP $300.00 $222.00 $0.00 $240.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $222.66 $222.66 $231.24 $0.00 $62.52 $0.00 $0.00 $0.00 $0.00 $150.00 $237.60 $240.00 $0.00 $195.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011258 EAP Custom 27011258 Tube Jejunostomy Feed 14 Fr BOTH IP/OP $501.00 $370.74 $0.00 $400.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $371.84 $371.84 $386.17 $0.00 $104.41 $0.00 $0.00 $0.00 $0.00 $250.50 $396.79 $400.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011259 EAP Custom 27011259 Tube Salem Silicone Size BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011260 EAP Custom 27011260 Tube Salem Sump 48 Lengt BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011261 EAP Custom 27011261 Tube Tj Feeding 18 Fr 45cm End BOTH IP/OP $651.00 $481.74 $0.00 $520.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $483.17 $483.17 $501.79 $0.00 $135.67 $0.00 $0.00 $0.00 $0.00 $325.50 $515.59 $520.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011262 EAP Custom 27011262 Tube Tj Feeding 22 Fr 45cm End BOTH IP/OP $651.00 $481.74 $0.00 $520.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $483.17 $483.17 $501.79 $0.00 $135.67 $0.00 $0.00 $0.00 $0.00 $325.50 $515.59 $520.80 $0.00 $423.15 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011263 EAP Custom 27011263 Tubes Extension Plain Pla BOTH IP/OP $15.00 $11.10 $0.00 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.13 $11.13 $11.56 $0.00 $3.13 $0.00 $0.00 $0.00 $0.00 $7.50 $11.88 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011265 EAP Custom 27011265 Tubes Extension Plain Pla BOTH IP/OP $15.00 $11.10 $0.00 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.13 $11.13 $11.56 $0.00 $3.13 $0.00 $0.00 $0.00 $0.00 $7.50 $11.88 $12.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011266 EAP Custom 27011266 Tubes Salem Sump 48 Leng BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011267 EAP Custom 27011267 Ultrasound Probe Covers BOTH IP/OP $46.00 $34.04 $0.00 $36.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $34.14 $34.14 $35.46 $0.00 $9.59 $0.00 $0.00 $0.00 $0.00 $23.00 $36.43 $36.80 $0.00 $29.90 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011268 EAP Custom 27011268 Valve Reflux BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011269 EAP Custom 27011269 Valve Reflux BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011270 EAP Custom 27011270 .014 Nitrex Guidewire BOTH IP/OP "$1,219.00 " $902.06 $0.00 $975.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $904.74 $904.74 $939.61 $0.00 $254.04 $0.00 $0.00 $0.00 $0.00 $609.50 $965.45 $975.20 $0.00 $792.35 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011301 EAP Custom 27011301 Drsg Anti Sft Sil 8x20 20x50cm BOTH IP/OP $248.00 $183.52 $0.00 $198.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $184.07 $184.07 $191.16 $0.00 $51.68 $0.00 $0.00 $0.00 $0.00 $124.00 $196.42 $198.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011302 EAP Custom 27011302 Drsg Anti Sft Sil 8x20 20x50cm BOTH IP/OP $248.00 $183.52 $0.00 $198.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $184.07 $184.07 $191.16 $0.00 $51.68 $0.00 $0.00 $0.00 $0.00 $124.00 $196.42 $198.40 $0.00 $161.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011304 EAP Custom 27011304 Blood Administration Set BOTH IP/OP $111.00 $82.14 $0.00 $88.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $82.38 $82.38 $85.56 $0.00 $23.13 $0.00 $0.00 $0.00 $0.00 $55.50 $87.91 $88.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011305 EAP Custom 27011305 Drsng Anti Sft Sil 6x6 15x15cm BOTH IP/OP $63.00 $46.62 $0.00 $50.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $46.76 $46.76 $48.56 $0.00 $13.13 $0.00 $0.00 $0.00 $0.00 $31.50 $49.90 $50.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011306 EAP Custom 27011306 Drsng Anti Sft Sil 6x6 15x15cm BOTH IP/OP $63.00 $46.62 $0.00 $50.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $46.76 $46.76 $48.56 $0.00 $13.13 $0.00 $0.00 $0.00 $0.00 $31.50 $49.90 $50.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011308 EAP Custom 27011308 Drsng Anti Sft Sil 4x4 10x10cm BOTH IP/OP $28.00 $20.72 $0.00 $22.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $20.78 $20.78 $21.58 $0.00 $5.84 $0.00 $0.00 $0.00 $0.00 $14.00 $22.18 $22.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011309 EAP Custom 27011309 Drsng Anti Sft Sil 4x4 10x10cm BOTH IP/OP $28.00 $20.72 $0.00 $22.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $20.78 $20.78 $21.58 $0.00 $5.84 $0.00 $0.00 $0.00 $0.00 $14.00 $22.18 $22.40 $0.00 $18.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011310 EAP HCPCS C1769 Volcano Combowire BOTH IP/OP "$3,669.00 " "$2,715.06" $0.00 "$2,935.20" "$1,992.27" "$1,992.27" $0.00 $0.00 $0.00 $764.71 "$2,723.13" "$2,723.13" "$2,828.07" $0.00 $764.62 $0.00 "$2,170.21" "$2,170.21" $0.00 "$1,834.50" "$2,905.85" "$2,935.20" $0.00 $0.00 $0.00 $574.20 $0.00 $0.00 $584.10 $0.00 $0.00 $0.00 $0.00 $0.00 27011320 EAP Custom 27011320 Tubes Salem Sump 48 Leng BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011323 EAP Custom 27011323 Jcd 9.0-38-20 BOTH IP/OP $42.00 $31.08 $0.00 $33.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $31.17 $31.17 $32.37 $0.00 $8.75 $0.00 $0.00 $0.00 $0.00 $21.00 $33.26 $33.60 $0.00 $27.30 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011324 EAP Custom 27011324 Jcd 6.0-38-20 BOTH IP/OP $167.00 $123.58 $0.00 $133.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $83.50 $132.26 $133.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011325 EAP Custom 27011325 Tube Salem Sump 48 Lengt BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011326 EAP Custom 27011326 Tubes Salem Sump 48 Leng BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011327 EAP Custom 27011327 Jcd 9.0-38-20 BOTH IP/OP $42.00 $31.08 $0.00 $33.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $31.17 $31.17 $32.37 $0.00 $8.75 $0.00 $0.00 $0.00 $0.00 $21.00 $33.26 $33.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011328 EAP Custom 27011328 Jcd 6.0-38-20 BOTH IP/OP $40.00 $29.60 $0.00 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $29.69 $29.69 $30.83 $0.00 $8.34 $0.00 $0.00 $0.00 $0.00 $20.00 $31.68 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011401 EAP Custom 27011401 Super Arrow Flex Introducer - BOTH IP/OP $251.00 $185.74 $0.00 $200.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $186.29 $186.29 $193.47 $0.00 $52.31 $0.00 $0.00 $0.00 $0.00 $125.50 $198.79 $200.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011410 EAP Custom 27011410 Tube Trach #8 Dct BOTH IP/OP $131.00 $96.94 $0.00 $104.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $97.23 $97.23 $100.97 $0.00 $27.30 $0.00 $0.00 $0.00 $0.00 $65.50 $103.75 $104.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011411 EAP Custom 27011411 Tube Trache 8-dcfs BOTH IP/OP $126.00 $93.24 $0.00 $100.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $93.52 $93.52 $97.12 $0.00 $26.26 $0.00 $0.00 $0.00 $0.00 $63.00 $99.79 $100.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011413 EAP Custom 27011413 Bag Resusitator Adult BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $0.00 $0.00 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011421 EAP Custom 27011421 Blade On Titanium Lopro S3 BOTH IP/OP $95.00 $70.30 $0.00 $76.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $70.51 $70.51 $73.23 $0.00 $19.80 $0.00 $0.00 $0.00 $0.00 $47.50 $75.24 $76.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011422 EAP Custom 27011422 Blade On Titanium Lopro S4 BOTH IP/OP $95.00 $70.30 $0.00 $76.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $70.51 $70.51 $73.23 $0.00 $19.80 $0.00 $0.00 $0.00 $0.00 $47.50 $75.24 $76.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011423 EAP Custom 27011423 Kit 135cm 2.7fr 20mm Img 1 Syr Rapex Tip Radiopq BOTH IP/OP "$1,875.00 " "$1,387.50" $0.00 "$1,500.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,391.63" "$1,391.63" "$1,445.25" $0.00 $390.75 $0.00 $0.00 $0.00 $0.00 $937.50 "$1,485.00" "$1,500.00" $0.00 "$1,218.75" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011425 EAP Custom 27011425 Mic Transgastric Jejunal Feeding Kit 18f 45cm BOTH IP/OP $500.00 $370.00 $0.00 $400.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $371.10 $371.10 $385.40 $0.00 $104.20 $0.00 $0.00 $0.00 $0.00 $250.00 $396.00 $400.00 $0.00 $325.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011426 EAP HCPCS C1729 Catheter Urethral 16fr Foley 2 BOTH IP/OP $224.00 $165.76 $0.00 $179.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $112.00 $177.41 $179.20 $0.00 $0.00 $0.00 $35.06 $0.00 $0.00 $35.66 $0.00 $0.00 $0.00 $0.00 $0.00 27011427 EAP HCPCS A4649 Medihoney Dressing 1.5oz Tube BOTH IP/OP $28.00 $20.72 $0.00 $22.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.00 $22.18 $22.40 $0.00 $0.00 $0.00 $4.38 $0.00 $0.00 $4.46 $0.00 $0.00 $0.00 $0.00 $0.00 27011428 EAP Tube Gstrm 12fr 10cm 5-7ml Entuit Bln Rtnt BOTH IP/OP $90.00 $66.60 $0.00 $72.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $66.80 $66.80 $69.37 $0.00 $18.76 $0.00 $0.00 $0.00 $0.00 $45.00 $71.28 $72.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011429 EAP Tube Fd Std 14fr 10cm 5ml Entuit Thrive Bln Rtnt Sm Gstrm BOTH IP/OP $90.00 $66.60 $0.00 $72.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $66.80 $66.80 $69.37 $0.00 $18.76 $0.00 $0.00 $0.00 $0.00 $45.00 $71.28 $72.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011430 EAP Tube Fd Std 16fr 10cm 5ml Entuit Thrive Bln Rtnt Med Gstrm BOTH IP/OP $90.00 $66.60 $0.00 $72.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $66.80 $66.80 $69.37 $0.00 $18.76 $0.00 $0.00 $0.00 $0.00 $45.00 $71.28 $72.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011431 EAP Tube Gstrm Std 18fr 10cm 5ml 60ml Entuit Thrive Bln Rtnt BOTH IP/OP $90.00 $66.60 $0.00 $72.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $66.80 $66.80 $69.37 $0.00 $18.76 $0.00 $0.00 $0.00 $0.00 $45.00 $71.28 $72.00 $0.00 $58.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011432 EAP Tube Fd Std 20fr 10cm 20ml Entuit Thrive Bln Rtnt Lg Gstrm BOTH IP/OP $90.00 $66.60 $0.00 $72.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $66.80 $66.80 $69.37 $0.00 $18.76 $0.00 $0.00 $0.00 $0.00 $45.00 $71.28 $72.00 $0.00 $58.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011433 EAP Tube Fd Std 22fr 10cm 20ml Entuit Thrive Bln Rtnt Lg Gstrm BOTH IP/OP $90.00 $66.60 $0.00 $72.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $66.80 $66.80 $69.37 $0.00 $18.76 $0.00 $0.00 $0.00 $0.00 $45.00 $71.28 $72.00 $0.00 $58.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011434 EAP Tube Fd Std 24fr 10cm 20ml Entuit Thrive Bln Rtnt Lg Gstrm BOTH IP/OP $90.00 $66.60 $0.00 $72.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $66.80 $66.80 $69.37 $0.00 $18.76 $0.00 $0.00 $0.00 $0.00 $45.00 $71.28 $72.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011435 EAP Kit Tracheostomy 12.3mm 9mm Complete Set Inner Cannu BOTH IP/OP "$1,255.00 " $928.70 $0.00 "$1,004.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $931.46 $931.46 $967.35 $0.00 $261.54 $0.00 $0.00 $0.00 $0.00 $627.50 $993.96 "$1,004.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011436 EAP Kit Crntmy 25ga 5/8in Strl Rzr Ndl Drp BOTH IP/OP $701.00 $518.74 $0.00 $560.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $350.50 $555.19 $560.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27011437 EAP Custom 27011437 Blanket Wrm 84x36in Clr Strl Lf 24x48in 3m Br Hgr Full Acc BOTH IP/OP $63.00 $46.62 $0.00 $50.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $46.76 $46.76 $48.56 $0.00 $13.13 $0.00 $0.00 $0.00 $0.00 $31.50 $49.90 $50.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27100021 EAP Custom 27100021 Pad Gel Hypo-hyperthermia Large BOTH IP/OP "$2,481.00 " "$1,835.94" $0.00 "$1,984.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,841.40" "$1,841.40" "$1,912.35" $0.00 $517.04 $0.00 $0.00 $0.00 $0.00 "$1,240.50" "$1,964.95" "$1,984.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27100022 EAP HCPCS A4467 POSTERIOR ELBOW SPLINT BOTH IP/OP $112.00 $82.88 $0.00 $89.60 $60.82 $60.82 $0.00 $0.00 $0.00 $0.00 $83.13 $83.13 $86.33 $0.00 $23.34 $0.00 $0.00 $0.00 $0.00 $56.00 $88.70 $89.60 $0.00 $72.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27100023 EAP Custom 27100023 Mölnlycke Z-flo Fluidized Positioner Pad BOTH IP/OP $122.00 $90.28 $0.00 $97.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $90.55 $90.55 $94.04 $0.00 $25.42 $0.00 $0.00 $0.00 $0.00 $61.00 $96.62 $97.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27100031 EAP Custom 27100031 Resuscitator Manual Medium 10f BOTH IP/OP $27.00 $19.98 $0.00 $21.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $13.50 $21.38 $21.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27100040 EAP Sup Ortho Universal Abd Binder Velcro Closure BOTH IP/OP $538.00 $398.12 $0.00 $430.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $399.30 $399.30 $414.69 $0.00 $112.12 $0.00 $0.00 $0.00 $0.00 $269.00 $426.10 $430.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200003 EAP Custom 27200003 Chest Unit Drainage Pleur BOTH IP/OP $76.00 $56.24 $0.00 $60.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $56.41 $56.41 $58.58 $0.00 $15.84 $0.00 $0.00 $0.00 $0.00 $38.00 $60.19 $60.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200008 EAP HCPCS C1769 .014 Nitrex Guidewire BOTH IP/OP "$1,295.00 " $958.30 $0.00 "$1,036.00" $703.19 $703.19 $0.00 $0.00 $0.00 $269.91 $961.15 $961.15 $998.19 $0.00 $269.88 $0.00 $765.99 $765.99 $0.00 $647.50 "$1,025.64" "$1,036.00" $0.00 $0.00 $0.00 $202.67 $0.00 $0.00 $206.16 $0.00 $0.00 $0.00 $0.00 $0.00 27200011 EAP HCPCS C1729 Catheter Foley 16fr BOTH IP/OP $18.00 $13.32 $0.00 $14.40 $9.77 $9.77 $0.00 $0.00 $0.00 $3.75 $13.36 $13.36 $13.87 $0.00 $3.75 $0.00 $10.65 $10.65 $0.00 $9.00 $14.26 $14.40 $0.00 $11.70 $0.00 $2.82 $0.00 $0.00 $2.87 $0.00 $0.00 $0.00 $0.00 $0.00 27200019 EAP HCPCS C1729 Catheter Foley 5cc 14fr BOTH IP/OP $6.00 $4.44 $0.00 $4.80 $3.26 $3.26 $0.00 $0.00 $0.00 $1.25 $4.45 $4.45 $4.62 $0.00 $1.25 $0.00 $3.55 $3.55 $0.00 $3.00 $4.75 $4.80 $0.00 $0.00 $0.00 $0.94 $0.00 $0.00 $0.96 $0.00 $0.00 $0.00 $0.00 $0.00 27200021 EAP HCPCS C1729 Catheter Foley 30cc 28fr BOTH IP/OP $36.00 $26.64 $0.00 $28.80 $19.55 $19.55 $0.00 $0.00 $0.00 $7.50 $26.72 $26.72 $27.75 $0.00 $7.50 $0.00 $21.29 $21.29 $0.00 $18.00 $28.51 $28.80 $0.00 $0.00 $0.00 $5.63 $0.00 $0.00 $5.73 $0.00 $0.00 $0.00 $0.00 $0.00 27200024 EAP HCPCS C1729 Catheter Foley 3cc 10 Fr BOTH IP/OP $34.00 $25.16 $0.00 $27.20 $18.46 $18.46 $0.00 $0.00 $0.00 $7.09 $25.23 $25.23 $26.21 $0.00 $7.09 $0.00 $20.11 $20.11 $0.00 $17.00 $26.93 $27.20 $0.00 $0.00 $0.00 $5.32 $0.00 $0.00 $5.41 $0.00 $0.00 $0.00 $0.00 $0.00 27200025 EAP HCPCS C1729 Catheter Foley 5cc 12fr BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $10.32 $10.32 $0.00 $0.00 $0.00 $3.96 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $11.24 $11.24 $0.00 $9.50 $15.05 $15.20 $0.00 $0.00 $0.00 $2.97 $0.00 $0.00 $3.02 $0.00 $0.00 $0.00 $0.00 $0.00 27200026 EAP Custom 27200026 Dress Sofsorb Absorb Buttoc Sm BOTH IP/OP $64.00 $47.36 $0.00 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $47.50 $47.50 $49.33 $0.00 $13.34 $0.00 $0.00 $0.00 $0.00 $32.00 $50.69 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200027 EAP Custom 27200027 Dress Sofsorb Absorb Butto Lg BOTH IP/OP $97.00 $71.78 $0.00 $77.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $71.99 $71.99 $74.77 $0.00 $20.21 $0.00 $0.00 $0.00 $0.00 $48.50 $76.82 $77.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200028 EAP Custom 27200028 Dress Sofsorb Absorb Chest Ssm BOTH IP/OP $41.00 $30.34 $0.00 $32.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $30.43 $30.43 $31.60 $0.00 $8.54 $0.00 $0.00 $0.00 $0.00 $20.50 $32.47 $32.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200029 EAP Custom 27200029 Dress Sofsorb Absors Chest Ilg BOTH IP/OP $41.00 $30.34 $0.00 $32.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $30.43 $30.43 $31.60 $0.00 $8.54 $0.00 $0.00 $0.00 $0.00 $20.50 $32.47 $32.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200030 EAP Custom 27200030 Dress Sofsorb Absorb Xl Chest BOTH IP/OP $40.00 $29.60 $0.00 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $29.69 $29.69 $30.83 $0.00 $8.34 $0.00 $0.00 $0.00 $0.00 $20.00 $31.68 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200031 EAP Custom 27200031 Dressing Leg/hip Adult BOTH IP/OP $87.00 $64.38 $0.00 $69.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $64.57 $64.57 $67.06 $0.00 $18.13 $0.00 $0.00 $0.00 $0.00 $43.50 $68.90 $69.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200032 EAP Custom 27200032 Dressing Burn Gauze 17 Ply 36' BOTH IP/OP $40.00 $29.60 $0.00 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $29.69 $29.69 $30.83 $0.00 $8.34 $0.00 $0.00 $0.00 $0.00 $20.00 $31.68 $32.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200033 EAP HCPCS C1751 Kit Cath Triple Lumen 5.5 Pedi BOTH IP/OP $159.00 $117.66 $0.00 $127.20 $86.34 $86.34 $0.00 $0.00 $0.00 $33.14 $118.01 $118.01 $122.56 $0.00 $33.14 $0.00 $94.05 $94.05 $0.00 $79.50 $125.93 $127.20 $0.00 $0.00 $0.00 $24.88 $0.00 $0.00 $25.31 $0.00 $0.00 $0.00 $0.00 $0.00 27200035 EAP HCPCS C1751 Femoral Arterial Line Cath Kit BOTH IP/OP $873.00 $646.02 $0.00 $698.40 $474.04 $474.04 $0.00 $0.00 $0.00 $181.96 $647.94 $647.94 $672.91 $0.00 $181.93 $0.00 $516.38 $516.38 $0.00 $436.50 $691.42 $698.40 $0.00 $0.00 $0.00 $136.62 $0.00 $0.00 $138.98 $0.00 $0.00 $0.00 $0.00 $0.00 27200040 EAP Custom 27200040 Kit Transducer Monitoring BOTH IP/OP $145.00 $107.30 $0.00 $116.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $107.62 $107.62 $111.77 $0.00 $30.22 $0.00 $0.00 $0.00 $0.00 $72.50 $114.84 $116.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200041 EAP Custom 27200041 Kit Pressure Monitoring BOTH IP/OP $108.00 $79.92 $0.00 $86.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $80.16 $80.16 $83.25 $0.00 $22.51 $0.00 $0.00 $0.00 $0.00 $54.00 $85.54 $86.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200043 EAP HCPCS C1729 Catheter Foley 16fr BOTH IP/OP $6.00 $4.44 $0.00 $4.80 $3.26 $3.26 $0.00 $0.00 $0.00 $1.25 $4.45 $4.45 $4.62 $0.00 $1.25 $0.00 $3.55 $3.55 $0.00 $3.00 $4.75 $4.80 $0.00 $0.00 $0.00 $0.94 $0.00 $0.00 $0.96 $0.00 $0.00 $0.00 $0.00 $0.00 27200045 EAP Custom 27200045 Paracentesis Tray BOTH IP/OP $214.00 $158.36 $0.00 $171.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $158.83 $158.83 $164.95 $0.00 $44.60 $0.00 $0.00 $0.00 $0.00 $107.00 $169.49 $171.20 $0.00 $139.10 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200047 EAP Custom 27200047 Biliary Plastic Stents BOTH IP/OP "$1,091.00 " $807.34 $0.00 $872.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $809.74 $809.74 $840.94 $0.00 $227.36 $0.00 $0.00 $0.00 $0.00 $545.50 $864.07 $872.80 $0.00 $709.15 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200048 EAP HCPCS C1769 Hydratomes Rx Cannulating Sphi BOTH IP/OP "$3,556.00 " "$2,631.44" $0.00 "$2,844.80" "$1,930.91" "$1,930.91" $0.00 $0.00 $0.00 $741.16 "$2,639.26" "$2,639.26" "$2,740.96" $0.00 $741.07 $0.00 "$2,103.37" "$2,103.37" $0.00 "$1,778.00" "$2,816.35" "$2,844.80" $0.00 $0.00 $0.00 $556.51 $0.00 $0.00 $566.12 $0.00 $0.00 $0.00 $0.00 $0.00 27200049 EAP HCPCS C1769 Jagtomes Rx Cannulating Sphinc BOTH IP/OP "$1,255.00 " $928.70 $0.00 "$1,004.00" $681.47 $681.47 $0.00 $0.00 $0.00 $261.57 $931.46 $931.46 $967.35 $0.00 $261.54 $0.00 $742.33 $742.33 $0.00 $627.50 $993.96 "$1,004.00" $0.00 $815.75 $0.00 $196.41 $0.00 $0.00 $199.80 $0.00 $0.00 $0.00 $0.00 $0.00 27200050 EAP Custom 27200050 Extractor Balloon BOTH IP/OP "$1,388.00 " "$1,027.12" $0.00 "$1,110.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,030.17" "$1,030.17" "$1,069.87" $0.00 $289.26 $0.00 $0.00 $0.00 $0.00 $694.00 "$1,099.30" "$1,110.40" $0.00 $902.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200051 EAP Custom 27200051 Trapezoid Retrieval Baskets BOTH IP/OP "$2,263.00 " "$1,674.62" $0.00 "$1,810.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,679.60" "$1,679.60" "$1,744.32" $0.00 $471.61 $0.00 $0.00 $0.00 $0.00 "$1,131.50" "$1,792.30" "$1,810.40" $0.00 "$1,470.95" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200052 EAP Custom 27200052 Endoprosthesis Metal Stent BOTH IP/OP "$9,693.00 " "$7,172.82" $0.00 "$7,754.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$7,471.36" $0.00 "$2,020.02" $0.00 $0.00 $0.00 $0.00 "$4,846.50" "$7,676.86" "$7,754.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200053 EAP Custom 27200053 Esophageal Stent BOTH IP/OP "$11,672.00 " "$8,637.28" $0.00 "$9,337.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$8,996.78" $0.00 "$2,432.44" $0.00 $0.00 $0.00 $0.00 "$5,836.00" "$9,244.22" "$9,337.60" $0.00 "$7,586.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200054 EAP Custom 27200054 Colonic And Duodenal Stent BOTH IP/OP "$16,179.00 " "$11,972.46" $0.00 "$12,943.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$12,470.77" $0.00 "$3,371.70" $0.00 $0.00 $0.00 $0.00 "$8,089.50" "$12,813.77" "$12,943.20" $0.00 "$10,516.35" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200055 EAP HCPCS C1726 Cre Balloons BOTH IP/OP "$1,523.00 " "$1,127.02" $0.00 "$1,218.40" $826.99 $826.99 $0.00 $0.00 $0.00 $317.43 "$1,130.37" "$1,130.37" "$1,173.93" $0.00 $317.39 $0.00 $900.85 $900.85 $0.00 $761.50 "$1,206.22" "$1,218.40" $0.00 $989.95 $0.00 $238.35 $0.00 $0.00 $242.46 $0.00 $0.00 $0.00 $0.00 $0.00 27200056 EAP Custom 27200056 Esophageal/pyloric Balloon Dil BOTH IP/OP "$1,750.00 " "$1,295.00" $0.00 "$1,400.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,298.85" "$1,298.85" "$1,348.90" $0.00 $364.70 $0.00 $0.00 $0.00 $0.00 $875.00 "$1,386.00" "$1,400.00" $0.00 "$1,137.50" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200057 EAP Custom 27200057 Esophageal/pyloric/colonic Ba BOTH IP/OP "$1,750.00 " "$1,295.00" $0.00 "$1,400.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,298.85" "$1,298.85" "$1,348.90" $0.00 $364.70 $0.00 $0.00 $0.00 $0.00 $875.00 "$1,386.00" "$1,400.00" $0.00 "$1,137.50" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200058 EAP Custom 27200058 O2 Supply-each BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $29.50 $46.73 $47.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200060 EAP Custom 27200060 Venous Port - Maintenance BOTH IP/OP $184.00 $136.16 $0.00 $147.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $136.56 $136.56 $141.83 $0.00 $38.35 $0.00 $0.00 $0.00 $0.00 $92.00 $145.73 $147.20 $0.00 $119.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200061 EAP Custom 27200061 Dressing BOTH IP/OP $42.00 $31.08 $0.00 $33.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $31.17 $31.17 $32.37 $0.00 $8.75 $0.00 $0.00 $0.00 $0.00 $21.00 $33.26 $33.60 $0.00 $27.30 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200062 EAP Custom 27200062 "Dressing, Burn Supplies" BOTH IP/OP $206.00 $152.44 $0.00 $164.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $152.89 $152.89 $158.78 $0.00 $42.93 $0.00 $0.00 $0.00 $0.00 $103.00 $163.15 $164.80 $0.00 $133.90 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200063 EAP Custom 27200063 Iv Start Supply BOTH IP/OP $228.00 $168.72 $0.00 $182.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $169.22 $169.22 $175.74 $0.00 $47.52 $0.00 $0.00 $0.00 $0.00 $114.00 $180.58 $182.40 $0.00 $148.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200064 EAP Custom 27200064 "Dressing, Burn Supplies" BOTH IP/OP $193.00 $142.82 $0.00 $154.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $143.24 $143.24 $148.76 $0.00 $40.22 $0.00 $0.00 $0.00 $0.00 $96.50 $152.86 $154.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200065 EAP Custom 27200065 Splint Supply BOTH IP/OP $64.00 $47.36 $0.00 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $47.50 $47.50 $49.33 $0.00 $13.34 $0.00 $0.00 $0.00 $0.00 $32.00 $50.69 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200066 EAP Custom 27200066 Nephrostomy Bag BOTH IP/OP $299.00 $221.26 $0.00 $239.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $221.92 $221.92 $230.47 $0.00 $62.31 $0.00 $0.00 $0.00 $0.00 $149.50 $236.81 $239.20 $0.00 $194.35 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200067 EAP Custom 27200067 Dressing Change BOTH IP/OP $64.00 $47.36 $0.00 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $47.50 $47.50 $49.33 $0.00 $13.34 $0.00 $0.00 $0.00 $0.00 $32.00 $50.69 $51.20 $0.00 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200068 EAP HCPCS C1729 Catheter Foley BOTH IP/OP $34.00 $25.16 $0.00 $27.20 $18.46 $18.46 $0.00 $0.00 $0.00 $7.09 $25.23 $25.23 $26.21 $0.00 $7.09 $0.00 $20.11 $20.11 $0.00 $17.00 $26.93 $27.20 $0.00 $22.10 $0.00 $5.32 $0.00 $0.00 $5.41 $0.00 $0.00 $0.00 $0.00 $0.00 27200069 EAP Custom 27200069 Leg Bag BOTH IP/OP $34.00 $25.16 $0.00 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $25.23 $25.23 $26.21 $0.00 $7.09 $0.00 $0.00 $0.00 $0.00 $17.00 $26.93 $27.20 $0.00 $22.10 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200070 EAP Custom 27200070 Urinary Drainage Bag BOTH IP/OP $47.00 $34.78 $0.00 $37.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $34.88 $34.88 $36.23 $0.00 $9.79 $0.00 $0.00 $0.00 $0.00 $23.50 $37.22 $37.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200074 EAP Custom 27200074 Acticoat Dressing BOTH IP/OP $315.00 $233.10 $0.00 $252.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $233.79 $233.79 $242.80 $0.00 $65.65 $0.00 $0.00 $0.00 $0.00 $157.50 $249.48 $252.00 $0.00 $204.75 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200075 EAP Custom 27200075 Feeding/ng Tube BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $0.00 $0.00 $0.00 $9.50 $15.05 $15.20 $0.00 $12.35 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200076 EAP Custom 27200076 Triple Lumen Cath BOTH IP/OP $222.00 $164.28 $0.00 $177.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $164.77 $164.77 $171.12 $0.00 $46.26 $0.00 $0.00 $0.00 $0.00 $111.00 $175.82 $177.60 $0.00 $144.30 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200077 EAP Custom 27200077 Transvenous Pacing Electrode BOTH IP/OP $389.00 $287.86 $0.00 $311.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $288.72 $288.72 $299.84 $0.00 $81.07 $0.00 $0.00 $0.00 $0.00 $194.50 $308.09 $311.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200080 EAP Custom 27200080 "Injection, Iv, Antibiotic" BOTH IP/OP $214.00 $158.36 $0.00 $171.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $158.83 $158.83 $164.95 $0.00 $44.60 $0.00 $0.00 $0.00 $0.00 $107.00 $169.49 $171.20 $0.00 $139.10 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200081 EAP Custom 27200081 "Steroid Injection, Iv Supply" BOTH IP/OP $192.00 $142.08 $0.00 $153.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $142.50 $142.50 $147.99 $0.00 $40.01 $0.00 $0.00 $0.00 $0.00 $96.00 $152.06 $153.60 $0.00 $124.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200082 EAP Custom 27200082 "Iv Start, Supply" BOTH IP/OP $228.00 $168.72 $0.00 $182.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $47.52 $0.00 $0.00 $0.00 $0.00 $114.00 $180.58 $182.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200084 EAP Custom 27200084 Emerg Infus Catheter BOTH IP/OP $264.00 $195.36 $0.00 $211.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $132.00 $209.09 $211.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200085 EAP Custom 27200085 "Ett, Laser" BOTH IP/OP $897.00 $663.78 $0.00 $717.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $665.75 $665.75 $691.41 $0.00 $186.93 $0.00 $0.00 $0.00 $0.00 $448.50 $710.42 $717.60 $0.00 $583.05 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200086 EAP Custom 27200086 "Ett, Rae" BOTH IP/OP $118.00 $87.32 $0.00 $94.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $87.58 $87.58 $90.95 $0.00 $24.59 $0.00 $0.00 $0.00 $0.00 $59.00 $93.46 $94.40 $0.00 $76.70 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200087 EAP Custom 27200087 "Ett, Wire Reinf" BOTH IP/OP $362.00 $267.88 $0.00 $289.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $268.68 $268.68 $279.03 $0.00 $75.44 $0.00 $0.00 $0.00 $0.00 $181.00 $286.70 $289.60 $0.00 $235.30 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200088 EAP Custom 27200088 "Ett, Endotrol/mlt" BOTH IP/OP $138.00 $102.12 $0.00 $110.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $102.42 $102.42 $106.37 $0.00 $28.76 $0.00 $0.00 $0.00 $0.00 $69.00 $109.30 $110.40 $0.00 $89.70 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200090 EAP Custom 27200090 "Cvp Kit, Single Lumen" BOTH IP/OP $238.00 $176.12 $0.00 $190.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $176.64 $176.64 $183.45 $0.00 $49.60 $0.00 $0.00 $0.00 $0.00 $119.00 $188.50 $190.40 $0.00 $154.70 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200091 EAP HCPCS C1756 Swan Paceport Cath BOTH IP/OP $666.00 $492.84 $0.00 $532.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $494.31 $494.31 $513.35 $0.00 $138.79 $0.00 $0.00 $0.00 $0.00 $333.00 $527.47 $532.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200092 EAP HCPCS C1751 Cvp Kit Triple Lumen BOTH IP/OP $569.00 $421.06 $0.00 $455.20 $308.97 $308.97 $0.00 $0.00 $0.00 $118.59 $422.31 $422.31 $438.59 $0.00 $118.58 $0.00 $336.56 $336.56 $0.00 $284.50 $450.65 $455.20 $0.00 $369.85 $0.00 $89.05 $0.00 $0.00 $90.58 $0.00 $0.00 $0.00 $0.00 $0.00 27200093 EAP HCPCS C1756 Swan Ganz Cath-bipolar Pacing BOTH IP/OP "$1,225.00 " $906.50 $0.00 $980.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $909.20 $909.20 $944.23 $0.00 $255.29 $0.00 $0.00 $0.00 $0.00 $612.50 $970.20 $980.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200094 EAP HCPCS C1756 Swan Pacing Td BOTH IP/OP "$2,409.00 " "$1,782.66" $0.00 "$1,927.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,787.96" "$1,787.96" "$1,856.86" $0.00 $502.04 $0.00 $0.00 $0.00 $0.00 "$1,204.50" "$1,907.93" "$1,927.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200096 EAP Custom 27200096 Adult Iv Set-up BOTH IP/OP $26.00 $19.24 $0.00 $20.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $19.30 $19.30 $20.04 $0.00 $5.42 $0.00 $0.00 $0.00 $0.00 $13.00 $20.59 $20.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200097 EAP Custom 27200097 "Ett, Endotrol/mlt" BOTH IP/OP $60.00 $44.40 $0.00 $48.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $44.53 $44.53 $46.25 $0.00 $12.50 $0.00 $0.00 $0.00 $0.00 $30.00 $47.52 $48.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200098 EAP Custom 27200098 "Cvp Kit, Single Lumen" BOTH IP/OP $238.00 $176.12 $0.00 $190.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $176.64 $176.64 $183.45 $0.00 $49.60 $0.00 $0.00 $0.00 $0.00 $119.00 $188.50 $190.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200099 EAP HCPCS C1756 Swan Paceport Cath BOTH IP/OP $634.00 $469.16 $0.00 $507.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $470.55 $470.55 $488.69 $0.00 $132.13 $0.00 $0.00 $0.00 $0.00 $317.00 $502.13 $507.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200100 EAP Custom 27200100 Cvp Kit Triple Lumen BOTH IP/OP $141.00 $104.34 $0.00 $112.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $104.65 $104.65 $108.68 $0.00 $29.38 $0.00 $0.00 $0.00 $0.00 $70.50 $111.67 $112.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200101 EAP HCPCS C1756 Swan Bipolar BOTH IP/OP "$1,225.00 " $906.50 $0.00 $980.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $909.20 $909.20 $944.23 $0.00 $255.29 $0.00 $0.00 $0.00 $0.00 $612.50 $970.20 $980.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200102 EAP HCPCS C1756 Swan Pacing Td BOTH IP/OP "$2,409.00 " "$1,782.66" $0.00 "$1,927.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,787.96" "$1,787.96" "$1,856.86" $0.00 $502.04 $0.00 $0.00 $0.00 $0.00 "$1,204.50" "$1,907.93" "$1,927.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200104 EAP HCPCS C1729 Catheter Foley 30cc 28fr BOTH IP/OP $37.00 $27.38 $0.00 $29.60 $20.09 $20.09 $0.00 $0.00 $0.00 $7.71 $27.46 $27.46 $28.52 $0.00 $7.71 $0.00 $21.89 $21.89 $0.00 $18.50 $29.30 $29.60 $0.00 $0.00 $0.00 $5.79 $0.00 $0.00 $5.89 $0.00 $0.00 $0.00 $0.00 $0.00 27200107 EAP HCPCS L8680 Implt Neurostim Elctr Each BOTH IP/OP "$1,605.00 " "$1,187.70" $0.00 "$1,284.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,191.23" "$1,191.23" "$1,237.13" $0.00 $334.48 $0.00 $0.00 $0.00 $0.00 $802.50 "$1,271.16" "$1,284.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200108 EAP Custom 27200108 Regional Nerve Block Tray BOTH IP/OP $88.00 $65.12 $0.00 $70.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $65.31 $65.31 $67.83 $0.00 $18.34 $0.00 $0.00 $0.00 $0.00 $44.00 $69.70 $70.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200109 EAP Custom 27200109 Epidural Tray BOTH IP/OP $160.00 $118.40 $0.00 $128.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $118.75 $118.75 $123.33 $0.00 $33.34 $0.00 $0.00 $0.00 $0.00 $80.00 $126.72 $128.00 $0.00 $104.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200110 EAP Custom 27200110 Insulated Block Needle BOTH IP/OP $46.00 $34.04 $0.00 $36.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $34.14 $34.14 $35.46 $0.00 $9.59 $0.00 $0.00 $0.00 $0.00 $23.00 $36.43 $36.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200111 EAP Custom 27200111 O2 Therapy-ea 8 Hrs BOTH IP/OP $296.00 $219.04 $0.00 $236.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $219.69 $219.69 $228.16 $0.00 $61.69 $0.00 $0.00 $0.00 $0.00 $148.00 $234.43 $236.80 $0.00 $192.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200113 EAP Custom 27200113 Peak Flow Meter BOTH IP/OP $487.00 $360.38 $0.00 $389.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $361.45 $361.45 $375.38 $0.00 $101.49 $0.00 $0.00 $0.00 $0.00 $243.50 $385.70 $389.60 $0.00 $316.55 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200114 EAP Custom 27200114 Heart Nebulizer BOTH IP/OP $440.00 $325.60 $0.00 $352.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $326.57 $326.57 $339.15 $0.00 $91.70 $0.00 $0.00 $0.00 $0.00 $220.00 $348.48 $352.00 $0.00 $286.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200115 EAP Custom 27200115 Mini Heart BOTH IP/OP $424.00 $313.76 $0.00 $339.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $314.69 $314.69 $326.82 $0.00 $88.36 $0.00 $0.00 $0.00 $0.00 $212.00 $335.81 $339.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200116 EAP Custom 27200116 Mdi Spacer BOTH IP/OP $192.00 $142.08 $0.00 $153.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $142.50 $142.50 $147.99 $0.00 $40.01 $0.00 $0.00 $0.00 $0.00 $96.00 $152.06 $153.60 $0.00 $124.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200117 EAP Custom 27200117 Inc Spir-disposable BOTH IP/OP $319.00 $236.06 $0.00 $255.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $236.76 $236.76 $245.89 $0.00 $66.48 $0.00 $0.00 $0.00 $0.00 $159.50 $252.65 $255.20 $0.00 $207.35 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200118 EAP Custom 27200118 Inner Cannula BOTH IP/OP $134.00 $99.16 $0.00 $107.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $99.45 $99.45 $103.29 $0.00 $27.93 $0.00 $0.00 $0.00 $0.00 $67.00 $106.13 $107.20 $0.00 $87.10 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200119 EAP Custom 27200119 Nasal Prongs BOTH IP/OP $26.00 $19.24 $0.00 $20.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $19.30 $19.30 $20.04 $0.00 $5.42 $0.00 $0.00 $0.00 $0.00 $13.00 $20.59 $20.80 $0.00 $16.90 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200120 EAP Custom 27200120 Vent Kit Only BOTH IP/OP $500.00 $370.00 $0.00 $400.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $371.10 $371.10 $385.40 $0.00 $104.20 $0.00 $0.00 $0.00 $0.00 $250.00 $396.00 $400.00 $0.00 $325.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200124 EAP Custom 27200124 Meter Astech Peak Flow BOTH IP/OP $49.00 $36.26 $0.00 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $36.37 $36.37 $37.77 $0.00 $10.21 $0.00 $0.00 $0.00 $0.00 $24.50 $38.81 $39.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200125 EAP Custom 27200125 Sleep Apnea Supply Kit BOTH IP/OP "$1,443.00 " "$1,067.82" $0.00 "$1,154.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,070.99" "$1,070.99" "$1,112.26" $0.00 $300.72 $0.00 $0.00 $0.00 $0.00 $721.50 "$1,142.86" "$1,154.40" $0.00 $937.95 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200126 EAP Custom 27200126 Tracheostomy-pipe Cleaner BOTH IP/OP $84.00 $62.16 $0.00 $67.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $62.34 $62.34 $64.75 $0.00 $17.51 $0.00 $0.00 $0.00 $0.00 $42.00 $66.53 $67.20 $0.00 $54.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200128 EAP Custom 27200128 Tube Trach #8 Dct BOTH IP/OP $377.00 $278.98 $0.00 $301.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $279.81 $279.81 $290.59 $0.00 $78.57 $0.00 $0.00 $0.00 $0.00 $188.50 $298.58 $301.60 $0.00 $245.05 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200129 EAP Custom 27200129 Tube Trach #6 Dct BOTH IP/OP $377.00 $278.98 $0.00 $301.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $279.81 $279.81 $290.59 $0.00 $78.57 $0.00 $0.00 $0.00 $0.00 $188.50 $298.58 $301.60 $0.00 $245.05 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200130 EAP Custom 27200130 Tube Trach #10 Dct BOTH IP/OP $335.00 $247.90 $0.00 $268.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $248.64 $248.64 $258.22 $0.00 $69.81 $0.00 $0.00 $0.00 $0.00 $167.50 $265.32 $268.00 $0.00 $217.75 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200131 EAP Custom 27200131 Tube Tracheostomy 4-dcfs BOTH IP/OP $342.00 $253.08 $0.00 $273.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $253.83 $253.83 $263.61 $0.00 $71.27 $0.00 $0.00 $0.00 $0.00 $171.00 $270.86 $273.60 $0.00 $222.30 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200132 EAP Custom 27200132 Tube Tracheostomy 8-dcfs BOTH IP/OP $326.00 $241.24 $0.00 $260.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $241.96 $241.96 $251.28 $0.00 $67.94 $0.00 $0.00 $0.00 $0.00 $163.00 $258.19 $260.80 $0.00 $211.90 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200133 EAP Custom 27200133 Mini Bal-broncho-alveolar Lava BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200134 EAP Custom 27200134 Cont Oxy Hood-pediatrics BOTH IP/OP $866.00 $640.84 $0.00 $692.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $642.75 $642.75 $667.51 $0.00 $180.47 $0.00 $0.00 $0.00 $0.00 $433.00 $685.87 $692.80 $0.00 $562.90 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200135 EAP Custom 27200135 He-ox Rx Airway Obs + Supply BOTH IP/OP $947.00 $700.78 $0.00 $757.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $702.86 $702.86 $729.95 $0.00 $197.35 $0.00 $0.00 $0.00 $0.00 $473.50 $750.02 $757.60 $0.00 $615.55 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200136 EAP Custom 27200136 Trach Tube/passy Muir BOTH IP/OP $554.00 $409.96 $0.00 $443.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $411.18 $411.18 $427.02 $0.00 $115.45 $0.00 $0.00 $0.00 $0.00 $277.00 $438.77 $443.20 $0.00 $360.10 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200137 EAP Custom 27200137 Intubation Specialty Tube BOTH IP/OP "$1,545.00 " "$1,143.30" $0.00 "$1,236.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,146.70" "$1,146.70" "$1,190.89" $0.00 $321.98 $0.00 $0.00 $0.00 $0.00 $772.50 "$1,223.64" "$1,236.00" $0.00 "$1,004.25" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200138 EAP Custom 27200138 Pulse Oximetry Sensor BOTH IP/OP $292.00 $216.08 $0.00 $233.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $216.72 $216.72 $225.07 $0.00 $60.85 $0.00 $0.00 $0.00 $0.00 $146.00 $231.26 $233.60 $0.00 $189.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200139 EAP Custom 27200139 Vent Circuit Kit BOTH IP/OP $423.00 $313.02 $0.00 $338.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $313.95 $313.95 $326.05 $0.00 $88.15 $0.00 $0.00 $0.00 $0.00 $211.50 $335.02 $338.40 $0.00 $274.95 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200140 EAP Custom 27200140 Specialty Vent Circuit Kit BOTH IP/OP $990.00 $732.60 $0.00 $792.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $734.78 $734.78 $763.09 $0.00 $206.32 $0.00 $0.00 $0.00 $0.00 $495.00 $784.08 $792.00 $0.00 $643.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200143 EAP Custom 27200143 Blood Gas Kit BOTH IP/OP $112.00 $82.88 $0.00 $89.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $83.13 $83.13 $86.33 $0.00 $23.34 $0.00 $0.00 $0.00 $0.00 $56.00 $88.70 $89.60 $0.00 $72.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200144 EAP HCPCS C1729 Red Rubber Catheter BOTH IP/OP $54.00 $39.96 $0.00 $43.20 $29.32 $29.32 $0.00 $0.00 $0.00 $11.25 $40.08 $40.08 $41.62 $0.00 $11.25 $0.00 $31.94 $31.94 $0.00 $27.00 $42.77 $43.20 $0.00 $35.10 $0.00 $8.45 $0.00 $0.00 $8.60 $0.00 $0.00 $0.00 $0.00 $0.00 27200145 EAP Custom 27200145 Air Vest-disposable BOTH IP/OP $675.00 $499.50 $0.00 $540.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $500.99 $500.99 $520.29 $0.00 $140.67 $0.00 $0.00 $0.00 $0.00 $337.50 $534.60 $540.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200148 EAP Custom 27200148 "Iv Start, Supply" BOTH IP/OP $65.00 $48.10 $0.00 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $48.24 $48.24 $50.10 $0.00 $13.55 $0.00 $0.00 $0.00 $0.00 $32.50 $51.48 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200149 EAP HCPCS C1769 Guidewire:pressurewire:radi BOTH IP/OP "$2,511.00 " "$1,858.14" $0.00 "$2,008.80" "$1,363.47" "$1,363.47" $0.00 $0.00 $0.00 $523.36 "$1,863.66" "$1,863.66" "$1,935.48" $0.00 $523.29 $0.00 "$1,485.26" "$1,485.26" $0.00 "$1,255.50" "$1,988.71" "$2,008.80" $0.00 $0.00 $0.00 $392.97 $0.00 $0.00 $399.75 $0.00 $0.00 $0.00 $0.00 $0.00 27200150 EAP Custom 27200150 Pericardiocentesis Kit BOTH IP/OP $591.00 $437.34 $0.00 $472.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $438.64 $438.64 $455.54 $0.00 $123.16 $0.00 $0.00 $0.00 $0.00 $295.50 $468.07 $472.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200151 EAP HCPCS C1769 Choice Pt X-support Guidewire BOTH IP/OP $605.00 $447.70 $0.00 $484.00 $328.52 $328.52 $0.00 $0.00 $0.00 $126.10 $449.03 $449.03 $466.33 $0.00 $126.08 $0.00 $357.86 $357.86 $0.00 $302.50 $479.16 $484.00 $0.00 $393.25 $0.00 $94.68 $0.00 $0.00 $96.32 $0.00 $0.00 $0.00 $0.00 $0.00 27200152 EAP HCPCS C1769 Choice Pt Guidewire BOTH IP/OP $605.00 $447.70 $0.00 $484.00 $328.52 $328.52 $0.00 $0.00 $0.00 $126.10 $449.03 $449.03 $466.33 $0.00 $126.08 $0.00 $357.86 $357.86 $0.00 $302.50 $479.16 $484.00 $0.00 $393.25 $0.00 $94.68 $0.00 $0.00 $96.32 $0.00 $0.00 $0.00 $0.00 $0.00 27200153 EAP HCPCS C1769 Glidewire .035 150cm Angled BOTH IP/OP $118.00 $87.32 $0.00 $94.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $59.00 $93.46 $94.40 $0.00 $0.00 $0.00 $18.47 $0.00 $0.00 $18.79 $0.00 $0.00 $0.00 $0.00 $0.00 27200154 EAP HCPCS C1892 Custom Left Heart Kit W/transd BOTH IP/OP $69.00 $51.06 $0.00 $55.20 $37.47 $37.47 $0.00 $0.00 $0.00 $14.38 $51.21 $51.21 $53.19 $0.00 $14.38 $0.00 $40.81 $40.81 $0.00 $34.50 $54.65 $55.20 $0.00 $44.85 $0.00 $10.80 $0.00 $0.00 $10.98 $0.00 $0.00 $0.00 $0.00 $0.00 27200155 EAP HCPCS C1892 Custom Right Heart Kit W/trans BOTH IP/OP $47.00 $34.78 $0.00 $37.60 $25.52 $25.52 $0.00 $0.00 $0.00 $9.80 $34.88 $34.88 $36.23 $0.00 $9.79 $0.00 $27.80 $27.80 $0.00 $23.50 $37.22 $37.60 $0.00 $0.00 $0.00 $7.36 $0.00 $0.00 $7.48 $0.00 $0.00 $0.00 $0.00 $0.00 27200156 EAP HCPCS C2629 Micropuncture Set BOTH IP/OP $102.00 $75.48 $0.00 $81.60 $0.00 $0.00 $0.00 $0.00 $0.00 $21.26 $75.70 $75.70 $78.62 $0.00 $21.26 $0.00 $60.33 $60.33 $0.00 $51.00 $80.78 $81.60 $0.00 $66.30 $0.00 $15.96 $0.00 $0.00 $16.24 $0.00 $0.00 $0.00 $0.00 $0.00 27200157 EAP HCPCS C1769 .025 X 260CM 7CM EMERALD GUIDEWIRE BOTH IP/OP $21.00 $15.54 $0.00 $16.80 $11.40 $11.40 $0.00 $0.00 $0.00 $4.38 $15.59 $15.59 $16.19 $0.00 $4.38 $0.00 $12.42 $12.42 $0.00 $10.50 $16.63 $16.80 $0.00 $13.65 $0.00 $3.29 $0.00 $0.00 $3.34 $0.00 $0.00 $0.00 $0.00 $0.00 27200158 EAP HCPCS C1887 6fr Al 1 St Guiding Cath BOTH IP/OP $199.00 $147.26 $0.00 $159.20 $108.06 $108.06 $0.00 $0.00 $0.00 $41.48 $147.70 $147.70 $153.39 $0.00 $41.47 $0.00 $117.71 $117.71 $0.00 $99.50 $157.61 $159.20 $0.00 $129.35 $0.00 $31.14 $0.00 $0.00 $31.68 $0.00 $0.00 $0.00 $0.00 $0.00 27200159 EAP HCPCS C1887 6fr Ar 2 Guiding Cath BOTH IP/OP $199.00 $147.26 $0.00 $159.20 $108.06 $108.06 $0.00 $0.00 $0.00 $41.48 $147.70 $147.70 $153.39 $0.00 $41.47 $0.00 $117.71 $117.71 $0.00 $99.50 $157.61 $159.20 $0.00 $0.00 $0.00 $31.14 $0.00 $0.00 $31.68 $0.00 $0.00 $0.00 $0.00 $0.00 27200160 EAP HCPCS C1894 6fr - 10cm Avanti + Sheath In BOTH IP/OP $34.00 $25.16 $0.00 $27.20 $18.46 $18.46 $0.00 $0.00 $0.00 $7.09 $25.23 $25.23 $26.21 $0.00 $7.09 $0.00 $20.11 $20.11 $0.00 $17.00 $26.93 $27.20 $0.00 $0.00 $0.00 $5.32 $0.00 $0.00 $5.41 $0.00 $0.00 $0.00 $0.00 $0.00 27200161 EAP HCPCS C1887 6fr Jl4 St Guiding Cath BOTH IP/OP $199.00 $147.26 $0.00 $159.20 $108.06 $108.06 $0.00 $0.00 $0.00 $41.48 $147.70 $147.70 $153.39 $0.00 $41.47 $0.00 $117.71 $117.71 $0.00 $99.50 $157.61 $159.20 $0.00 $0.00 $0.00 $31.14 $0.00 $0.00 $31.68 $0.00 $0.00 $0.00 $0.00 $0.00 27200162 EAP HCPCS C1887 6fr Mpa-1 Guiding Cath BOTH IP/OP $189.00 $139.86 $0.00 $151.20 $102.63 $102.63 $0.00 $0.00 $0.00 $39.39 $140.28 $140.28 $145.68 $0.00 $39.39 $0.00 $111.79 $111.79 $0.00 $94.50 $149.69 $151.20 $0.00 $122.85 $0.00 $29.58 $0.00 $0.00 $30.09 $0.00 $0.00 $0.00 $0.00 $0.00 27200163 EAP HCPCS C1887 6ft Jr 4 St Guiding Cath BOTH IP/OP $199.00 $147.26 $0.00 $159.20 $108.06 $108.06 $0.00 $0.00 $0.00 $41.48 $147.70 $147.70 $153.39 $0.00 $41.47 $0.00 $117.71 $117.71 $0.00 $99.50 $157.61 $159.20 $0.00 $129.35 $0.00 $31.14 $0.00 $0.00 $31.68 $0.00 $0.00 $0.00 $0.00 $0.00 27200164 EAP HCPCS C1887 7fr Ar 1 Guiding Cath BOTH IP/OP $161.00 $119.14 $0.00 $128.80 $87.42 $87.42 $0.00 $0.00 $0.00 $33.56 $119.49 $119.49 $124.10 $0.00 $33.55 $0.00 $95.23 $95.23 $0.00 $80.50 $127.51 $128.80 $0.00 $0.00 $0.00 $25.20 $0.00 $0.00 $25.63 $0.00 $0.00 $0.00 $0.00 $0.00 27200165 EAP HCPCS C1887 7fr Jr 3.5 Guiding Cath BOTH IP/OP $180.00 $133.20 $0.00 $144.00 $97.74 $97.74 $0.00 $0.00 $0.00 $37.52 $133.60 $133.60 $138.74 $0.00 $37.51 $0.00 $106.47 $106.47 $0.00 $90.00 $142.56 $144.00 $0.00 $0.00 $0.00 $28.17 $0.00 $0.00 $28.66 $0.00 $0.00 $0.00 $0.00 $0.00 27200166 EAP HCPCS C1887 7fr H-stick Guiding Cath BOTH IP/OP $180.00 $133.20 $0.00 $144.00 $97.74 $97.74 $0.00 $0.00 $0.00 $37.52 $133.60 $133.60 $138.74 $0.00 $37.51 $0.00 $106.47 $106.47 $0.00 $90.00 $142.56 $144.00 $0.00 $0.00 $0.00 $28.17 $0.00 $0.00 $28.66 $0.00 $0.00 $0.00 $0.00 $0.00 27200167 EAP HCPCS C1887 7fr Jl5 Guiding Cath BOTH IP/OP $161.00 $119.14 $0.00 $128.80 $87.42 $87.42 $0.00 $0.00 $0.00 $33.56 $119.49 $119.49 $124.10 $0.00 $33.55 $0.00 $95.23 $95.23 $0.00 $80.50 $127.51 $128.80 $0.00 $104.65 $0.00 $25.20 $0.00 $0.00 $25.63 $0.00 $0.00 $0.00 $0.00 $0.00 27200168 EAP HCPCS C1887 7fr Jr 4 St Guiding Cath BOTH IP/OP $199.00 $147.26 $0.00 $159.20 $108.06 $108.06 $0.00 $0.00 $0.00 $41.48 $147.70 $147.70 $153.39 $0.00 $41.47 $0.00 $117.71 $117.71 $0.00 $99.50 $157.61 $159.20 $0.00 $0.00 $0.00 $31.14 $0.00 $0.00 $31.68 $0.00 $0.00 $0.00 $0.00 $0.00 27200169 EAP HCPCS C1887 7fr Jr 5 Guiding Cath BOTH IP/OP $161.00 $119.14 $0.00 $128.80 $87.42 $87.42 $0.00 $0.00 $0.00 $33.56 $119.49 $119.49 $124.10 $0.00 $33.55 $0.00 $95.23 $95.23 $0.00 $80.50 $127.51 $128.80 $0.00 $104.65 $0.00 $25.20 $0.00 $0.00 $25.63 $0.00 $0.00 $0.00 $0.00 $0.00 27200170 EAP HCPCS C1887 7fr Mpa-1 Guiding Cath BOTH IP/OP $161.00 $119.14 $0.00 $128.80 $87.42 $87.42 $0.00 $0.00 $0.00 $33.56 $119.49 $119.49 $124.10 $0.00 $33.55 $0.00 $95.23 $95.23 $0.00 $80.50 $127.51 $128.80 $0.00 $104.65 $0.00 $25.20 $0.00 $0.00 $25.63 $0.00 $0.00 $0.00 $0.00 $0.00 27200171 EAP HCPCS C1887 7fr Xb 3.5 Guiding Cath BOTH IP/OP $199.00 $147.26 $0.00 $159.20 $108.06 $108.06 $0.00 $0.00 $0.00 $41.48 $147.70 $147.70 $153.39 $0.00 $41.47 $0.00 $117.71 $117.71 $0.00 $99.50 $157.61 $159.20 $0.00 $0.00 $0.00 $31.14 $0.00 $0.00 $31.68 $0.00 $0.00 $0.00 $0.00 $0.00 27200172 EAP HCPCS C1887 7fr Xb 3.0 Guiding Cath BOTH IP/OP $199.00 $147.26 $0.00 $159.20 $108.06 $108.06 $0.00 $0.00 $0.00 $41.48 $147.70 $147.70 $153.39 $0.00 $41.47 $0.00 $117.71 $117.71 $0.00 $99.50 $157.61 $159.20 $0.00 $0.00 $0.00 $31.14 $0.00 $0.00 $31.68 $0.00 $0.00 $0.00 $0.00 $0.00 27200173 EAP HCPCS C1887 7fr Al 1 St Guiding Cath BOTH IP/OP $199.00 $147.26 $0.00 $159.20 $108.06 $108.06 $0.00 $0.00 $0.00 $41.48 $147.70 $147.70 $153.39 $0.00 $41.47 $0.00 $117.71 $117.71 $0.00 $99.50 $157.61 $159.20 $0.00 $0.00 $0.00 $31.14 $0.00 $0.00 $31.68 $0.00 $0.00 $0.00 $0.00 $0.00 27200174 EAP HCPCS C1887 7fr Al 2 Guiding Cath BOTH IP/OP $161.00 $119.14 $0.00 $128.80 $87.42 $87.42 $0.00 $0.00 $0.00 $33.56 $119.49 $119.49 $124.10 $0.00 $33.55 $0.00 $95.23 $95.23 $0.00 $80.50 $127.51 $128.80 $0.00 $0.00 $0.00 $25.20 $0.00 $0.00 $25.63 $0.00 $0.00 $0.00 $0.00 $0.00 27200175 EAP HCPCS C1887 7fr Jr 4 Guiding Cath BOTH IP/OP $161.00 $119.14 $0.00 $128.80 $87.42 $87.42 $0.00 $0.00 $0.00 $33.56 $119.49 $119.49 $124.10 $0.00 $33.55 $0.00 $95.23 $95.23 $0.00 $80.50 $127.51 $128.80 $0.00 $0.00 $0.00 $25.20 $0.00 $0.00 $25.63 $0.00 $0.00 $0.00 $0.00 $0.00 27200176 EAP HCPCS C1887 7fr Im Guiding Cath BOTH IP/OP $180.00 $133.20 $0.00 $144.00 $97.74 $97.74 $0.00 $0.00 $0.00 $37.52 $133.60 $133.60 $138.74 $0.00 $37.51 $0.00 $106.47 $106.47 $0.00 $90.00 $142.56 $144.00 $0.00 $117.00 $0.00 $28.17 $0.00 $0.00 $28.66 $0.00 $0.00 $0.00 $0.00 $0.00 27200177 EAP HCPCS C1887 6fr Ar 1 Guiding Cath BOTH IP/OP $161.00 $119.14 $0.00 $128.80 $87.42 $87.42 $0.00 $0.00 $0.00 $33.56 $119.49 $119.49 $124.10 $0.00 $33.55 $0.00 $95.23 $95.23 $0.00 $80.50 $127.51 $128.80 $0.00 $104.65 $0.00 $25.20 $0.00 $0.00 $25.63 $0.00 $0.00 $0.00 $0.00 $0.00 27200178 EAP HCPCS C1887 6fr Jl4 Sh Guiding Cath BOTH IP/OP $161.00 $119.14 $0.00 $128.80 $87.42 $87.42 $0.00 $0.00 $0.00 $33.56 $119.49 $119.49 $124.10 $0.00 $33.55 $0.00 $95.23 $95.23 $0.00 $80.50 $127.51 $128.80 $0.00 $104.65 $0.00 $25.20 $0.00 $0.00 $25.63 $0.00 $0.00 $0.00 $0.00 $0.00 27200179 EAP HCPCS C1887 6fr Jr 4 Sh Guiding Cath BOTH IP/OP $161.00 $119.14 $0.00 $128.80 $87.42 $87.42 $0.00 $0.00 $0.00 $33.56 $119.49 $119.49 $124.10 $0.00 $33.55 $0.00 $95.23 $95.23 $0.00 $80.50 $127.51 $128.80 $0.00 $104.65 $0.00 $25.20 $0.00 $0.00 $25.63 $0.00 $0.00 $0.00 $0.00 $0.00 27200180 EAP HCPCS C1769 .035 X 260CM 3CM EMERALD GUIDEWIRE BOTH IP/OP $22.00 $16.28 $0.00 $17.60 $11.95 $11.95 $0.00 $0.00 $0.00 $4.59 $16.33 $16.33 $16.96 $0.00 $4.58 $0.00 $13.01 $13.01 $0.00 $11.00 $17.42 $17.60 $0.00 $14.30 $0.00 $3.44 $0.00 $0.00 $3.50 $0.00 $0.00 $0.00 $0.00 $0.00 27200181 EAP HCPCS C1887 6fr Xb 3 Sh Guiding Cath BOTH IP/OP $199.00 $147.26 $0.00 $159.20 $108.06 $108.06 $0.00 $0.00 $0.00 $41.48 $147.70 $147.70 $153.39 $0.00 $41.47 $0.00 $117.71 $117.71 $0.00 $99.50 $157.61 $159.20 $0.00 $0.00 $0.00 $31.14 $0.00 $0.00 $31.68 $0.00 $0.00 $0.00 $0.00 $0.00 27200182 EAP HCPCS C1887 7fr Xb 3.5 Sh Guilding Cath BOTH IP/OP $199.00 $147.26 $0.00 $159.20 $108.06 $108.06 $0.00 $0.00 $0.00 $41.48 $147.70 $147.70 $153.39 $0.00 $41.47 $0.00 $117.71 $117.71 $0.00 $99.50 $157.61 $159.20 $0.00 $0.00 $0.00 $31.14 $0.00 $0.00 $31.68 $0.00 $0.00 $0.00 $0.00 $0.00 27200183 EAP HCPCS C1887 6fr Xb 3.5 Sh Guiding Cath BOTH IP/OP $199.00 $147.26 $0.00 $159.20 $108.06 $108.06 $0.00 $0.00 $0.00 $41.48 $147.70 $147.70 $153.39 $0.00 $41.47 $0.00 $117.71 $117.71 $0.00 $99.50 $157.61 $159.20 $0.00 $0.00 $0.00 $31.14 $0.00 $0.00 $31.68 $0.00 $0.00 $0.00 $0.00 $0.00 27200184 EAP HCPCS C1769 .035 X 150CM 3CM EMERALD GUIDEWIRE BOTH IP/OP $22.00 $16.28 $0.00 $17.60 $11.95 $11.95 $0.00 $0.00 $0.00 $4.59 $16.33 $16.33 $16.96 $0.00 $4.58 $0.00 $13.01 $13.01 $0.00 $11.00 $17.42 $17.60 $0.00 $14.30 $0.00 $3.44 $0.00 $0.00 $3.50 $0.00 $0.00 $0.00 $0.00 $0.00 27200185 EAP HCPCS C1887 7fr Jl4 Guiding Cath BOTH IP/OP $161.00 $119.14 $0.00 $128.80 $87.42 $87.42 $0.00 $0.00 $0.00 $33.56 $119.49 $119.49 $124.10 $0.00 $33.55 $0.00 $95.23 $95.23 $0.00 $80.50 $127.51 $128.80 $0.00 $0.00 $0.00 $25.20 $0.00 $0.00 $25.63 $0.00 $0.00 $0.00 $0.00 $0.00 27200186 EAP HCPCS C1887 7fr Jl4 Sh Guiding Cath BOTH IP/OP $161.00 $119.14 $0.00 $128.80 $87.42 $87.42 $0.00 $0.00 $0.00 $33.56 $119.49 $119.49 $124.10 $0.00 $33.55 $0.00 $95.23 $95.23 $0.00 $80.50 $127.51 $128.80 $0.00 $104.65 $0.00 $25.20 $0.00 $0.00 $25.63 $0.00 $0.00 $0.00 $0.00 $0.00 27200187 EAP HCPCS C1887 7fr Xb 4.0 Guiding Cath BOTH IP/OP $199.00 $147.26 $0.00 $159.20 $108.06 $108.06 $0.00 $0.00 $0.00 $41.48 $147.70 $147.70 $153.39 $0.00 $41.47 $0.00 $117.71 $117.71 $0.00 $99.50 $157.61 $159.20 $0.00 $0.00 $0.00 $31.14 $0.00 $0.00 $31.68 $0.00 $0.00 $0.00 $0.00 $0.00 27200188 EAP HCPCS C1887 7fr Jr 4 Sh Guiding Cath BOTH IP/OP $161.00 $119.14 $0.00 $128.80 $87.42 $87.42 $0.00 $0.00 $0.00 $33.56 $119.49 $119.49 $124.10 $0.00 $33.55 $0.00 $95.23 $95.23 $0.00 $80.50 $127.51 $128.80 $0.00 $104.65 $0.00 $25.20 $0.00 $0.00 $25.63 $0.00 $0.00 $0.00 $0.00 $0.00 27200189 EAP HCPCS C1887 7fr Ar 1 Sh Guiding Cath BOTH IP/OP $180.00 $133.20 $0.00 $144.00 $97.74 $97.74 $0.00 $0.00 $0.00 $37.52 $133.60 $133.60 $138.74 $0.00 $37.51 $0.00 $106.47 $106.47 $0.00 $90.00 $142.56 $144.00 $0.00 $0.00 $0.00 $28.17 $0.00 $0.00 $28.66 $0.00 $0.00 $0.00 $0.00 $0.00 27200190 EAP HCPCS C1887 6fr Al 1 Guiding Cath BOTH IP/OP $161.00 $119.14 $0.00 $128.80 $87.42 $87.42 $0.00 $0.00 $0.00 $33.56 $119.49 $119.49 $124.10 $0.00 $33.55 $0.00 $95.23 $95.23 $0.00 $80.50 $127.51 $128.80 $0.00 $104.65 $0.00 $25.20 $0.00 $0.00 $25.63 $0.00 $0.00 $0.00 $0.00 $0.00 27200191 EAP HCPCS C1887 6fr Xb 4.0 Guiding Cath BOTH IP/OP $199.00 $147.26 $0.00 $159.20 $108.06 $108.06 $0.00 $0.00 $0.00 $41.48 $147.70 $147.70 $153.39 $0.00 $41.47 $0.00 $117.71 $117.71 $0.00 $99.50 $157.61 $159.20 $0.00 $0.00 $0.00 $31.14 $0.00 $0.00 $31.68 $0.00 $0.00 $0.00 $0.00 $0.00 27200192 EAP HCPCS C1887 7fr Al 1 Guiding Cath BOTH IP/OP $161.00 $119.14 $0.00 $128.80 $87.42 $87.42 $0.00 $0.00 $0.00 $33.56 $119.49 $119.49 $124.10 $0.00 $33.55 $0.00 $95.23 $95.23 $0.00 $80.50 $127.51 $128.80 $0.00 $104.65 $0.00 $25.20 $0.00 $0.00 $25.63 $0.00 $0.00 $0.00 $0.00 $0.00 27200193 EAP HCPCS C1887 6fr Jl4 Guiding Cath BOTH IP/OP $161.00 $119.14 $0.00 $128.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $80.50 $127.51 $128.80 $0.00 $0.00 $0.00 $25.20 $0.00 $0.00 $25.63 $0.00 $0.00 $0.00 $0.00 $0.00 27200194 EAP HCPCS C1887 6fr Jr 4 Guiding Cath BOTH IP/OP $189.00 $139.86 $0.00 $151.20 $102.63 $102.63 $0.00 $0.00 $0.00 $39.39 $140.28 $140.28 $145.68 $0.00 $39.39 $0.00 $111.79 $111.79 $0.00 $94.50 $149.69 $151.20 $0.00 $122.85 $0.00 $29.58 $0.00 $0.00 $30.09 $0.00 $0.00 $0.00 $0.00 $0.00 27200195 EAP HCPCS C1887 6fr Xb 3 Guiding Cath BOTH IP/OP $199.00 $147.26 $0.00 $159.20 $108.06 $108.06 $0.00 $0.00 $0.00 $41.48 $147.70 $147.70 $153.39 $0.00 $41.47 $0.00 $117.71 $117.71 $0.00 $99.50 $157.61 $159.20 $0.00 $129.35 $0.00 $31.14 $0.00 $0.00 $31.68 $0.00 $0.00 $0.00 $0.00 $0.00 27200196 EAP HCPCS C1887 6fr Xb 3.5 Guiding Cath BOTH IP/OP $199.00 $147.26 $0.00 $159.20 $108.06 $108.06 $0.00 $0.00 $0.00 $41.48 $147.70 $147.70 $153.39 $0.00 $41.47 $0.00 $117.71 $117.71 $0.00 $99.50 $157.61 $159.20 $0.00 $129.35 $0.00 $31.14 $0.00 $0.00 $31.68 $0.00 $0.00 $0.00 $0.00 $0.00 27200197 EAP HCPCS C1887 6fr H-stick Guiding Cath BOTH IP/OP $161.00 $119.14 $0.00 $128.80 $87.42 $87.42 $0.00 $0.00 $0.00 $33.56 $119.49 $119.49 $124.10 $0.00 $33.55 $0.00 $95.23 $95.23 $0.00 $80.50 $127.51 $128.80 $0.00 $0.00 $0.00 $25.20 $0.00 $0.00 $25.63 $0.00 $0.00 $0.00 $0.00 $0.00 27200198 EAP HCPCS C1887 6fr Jl3.5 Guiding Cath BOTH IP/OP $180.00 $133.20 $0.00 $144.00 $97.74 $97.74 $0.00 $0.00 $0.00 $37.52 $133.60 $133.60 $138.74 $0.00 $37.51 $0.00 $106.47 $106.47 $0.00 $90.00 $142.56 $144.00 $0.00 $117.00 $0.00 $28.17 $0.00 $0.00 $28.66 $0.00 $0.00 $0.00 $0.00 $0.00 27200199 EAP HCPCS C1887 6fr Jr 3.5 Guiding Cath BOTH IP/OP $161.00 $119.14 $0.00 $128.80 $87.42 $87.42 $0.00 $0.00 $0.00 $33.56 $119.49 $119.49 $124.10 $0.00 $33.55 $0.00 $95.23 $95.23 $0.00 $80.50 $127.51 $128.80 $0.00 $104.65 $0.00 $25.20 $0.00 $0.00 $25.63 $0.00 $0.00 $0.00 $0.00 $0.00 27200200 EAP HCPCS C1887 6fr Al .75 Guiding Cath BOTH IP/OP $161.00 $119.14 $0.00 $128.80 $87.42 $87.42 $0.00 $0.00 $0.00 $33.56 $119.49 $119.49 $124.10 $0.00 $33.55 $0.00 $95.23 $95.23 $0.00 $80.50 $127.51 $128.80 $0.00 $104.65 $0.00 $25.20 $0.00 $0.00 $25.63 $0.00 $0.00 $0.00 $0.00 $0.00 27200201 EAP HCPCS C1887 7fr Al .75 Guiding Cath BOTH IP/OP $161.00 $119.14 $0.00 $128.80 $87.42 $87.42 $0.00 $0.00 $0.00 $33.56 $119.49 $119.49 $124.10 $0.00 $33.55 $0.00 $95.23 $95.23 $0.00 $80.50 $127.51 $128.80 $0.00 $104.65 $0.00 $25.20 $0.00 $0.00 $25.63 $0.00 $0.00 $0.00 $0.00 $0.00 27200202 EAP HCPCS C1894 7fr - 10cm Avanti + Sheath Int BOTH IP/OP $34.00 $25.16 $0.00 $27.20 $18.46 $18.46 $0.00 $0.00 $0.00 $7.09 $25.23 $25.23 $26.21 $0.00 $7.09 $0.00 $20.11 $20.11 $0.00 $17.00 $26.93 $27.20 $0.00 $0.00 $0.00 $5.32 $0.00 $0.00 $5.41 $0.00 $0.00 $0.00 $0.00 $0.00 27200203 EAP HCPCS C1894 8fr - 10cm Avanti + Sheath Int BOTH IP/OP $34.00 $25.16 $0.00 $27.20 $18.46 $18.46 $0.00 $0.00 $0.00 $7.09 $25.23 $25.23 $26.21 $0.00 $7.09 $0.00 $20.11 $20.11 $0.00 $17.00 $26.93 $27.20 $0.00 $0.00 $0.00 $5.32 $0.00 $0.00 $5.41 $0.00 $0.00 $0.00 $0.00 $0.00 27200204 EAP HCPCS C1769 .025 X 150cm Emerald Guidewire BOTH IP/OP $21.00 $15.54 $0.00 $16.80 $11.40 $11.40 $0.00 $0.00 $0.00 $4.38 $15.59 $15.59 $16.19 $0.00 $4.38 $0.00 $12.42 $12.42 $0.00 $10.50 $16.63 $16.80 $0.00 $13.65 $0.00 $3.29 $0.00 $0.00 $3.34 $0.00 $0.00 $0.00 $0.00 $0.00 27200205 EAP HCPCS C1769 300cm Balanced Middleweight (b BOTH IP/OP $288.00 $213.12 $0.00 $230.40 $156.38 $156.38 $0.00 $0.00 $0.00 $60.03 $213.75 $213.75 $221.99 $0.00 $60.02 $0.00 $170.35 $170.35 $0.00 $144.00 $228.10 $230.40 $0.00 $0.00 $0.00 $45.07 $0.00 $0.00 $45.85 $0.00 $0.00 $0.00 $0.00 $0.00 27200206 EAP HCPCS C1769 Amplatz Guidewire Super Stiff BOTH IP/OP $87.00 $64.38 $0.00 $69.60 $47.24 $47.24 $0.00 $0.00 $0.00 $18.13 $64.57 $64.57 $67.06 $0.00 $18.13 $0.00 $51.46 $51.46 $0.00 $43.50 $68.90 $69.60 $0.00 $0.00 $0.00 $13.62 $0.00 $0.00 $13.85 $0.00 $0.00 $0.00 $0.00 $0.00 27200207 EAP HCPCS C1751 7fr-100cm Swan-ganz Td Cathete BOTH IP/OP $189.00 $139.86 $0.00 $151.20 $102.63 $102.63 $0.00 $0.00 $0.00 $39.39 $140.28 $140.28 $145.68 $0.00 $39.39 $0.00 $111.79 $111.79 $0.00 $94.50 $149.69 $151.20 $0.00 $122.85 $0.00 $29.58 $0.00 $0.00 $30.09 $0.00 $0.00 $0.00 $0.00 $0.00 27200208 EAP HCPCS C1894 5fr - 10cm Avanti+sheath Intro BOTH IP/OP $34.00 $25.16 $0.00 $27.20 $18.46 $18.46 $0.00 $0.00 $0.00 $7.09 $25.23 $25.23 $26.21 $0.00 $7.09 $0.00 $20.11 $20.11 $0.00 $17.00 $26.93 $27.20 $0.00 $0.00 $0.00 $5.32 $0.00 $0.00 $5.41 $0.00 $0.00 $0.00 $0.00 $0.00 27200209 EAP HCPCS C1887 7fr Jl4 St Guiding Cath BOTH IP/OP $161.00 $119.14 $0.00 $128.80 $87.42 $87.42 $0.00 $0.00 $0.00 $33.56 $119.49 $119.49 $124.10 $0.00 $33.55 $0.00 $95.23 $95.23 $0.00 $80.50 $127.51 $128.80 $0.00 $0.00 $0.00 $25.20 $0.00 $0.00 $25.63 $0.00 $0.00 $0.00 $0.00 $0.00 27200214 EAP HCPCS C1884 Filter Wire Ex-300cm BOTH IP/OP "$5,361.00 " "$3,967.14" $0.00 "$4,288.80" "$2,911.02" "$2,911.02" $0.00 $0.00 $0.00 "$1,117.37" "$3,978.93" "$3,978.93" "$4,132.26" $0.00 "$1,117.23" $0.00 "$3,094.73" "$3,094.73" $0.00 "$2,680.50" "$4,245.91" "$4,288.80" $0.00 "$3,484.65" $0.00 $839.00 $0.00 $0.00 $853.47 $0.00 $0.00 $0.00 $0.00 $0.00 27200215 EAP HCPCS C1727 2.50 X 15mm Cutting Balloon BOTH IP/OP "$2,869.00 " "$2,123.06" $0.00 "$2,295.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,129.37" "$2,129.37" "$2,211.43" $0.00 $597.90 $0.00 $0.00 $0.00 $0.00 "$1,434.50" "$2,272.25" "$2,295.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200216 EAP HCPCS C1727 2.50 X 10cm Cutting Balloon BOTH IP/OP "$2,869.00 " "$2,123.06" $0.00 "$2,295.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,129.37" "$2,129.37" "$2,211.43" $0.00 $597.90 $0.00 $0.00 $0.00 $0.00 "$1,434.50" "$2,272.25" "$2,295.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200218 EAP HCPCS C1757 .014-145cm Export Catheter BOTH IP/OP "$1,865.00 " "$1,380.10" $0.00 "$1,492.00" "$1,012.70" "$1,012.70" $0.00 $0.00 $0.00 $388.71 "$1,384.20" "$1,384.20" "$1,437.54" $0.00 $388.67 $0.00 "$1,103.15" "$1,103.15" $0.00 $932.50 "$1,477.08" "$1,492.00" $0.00 "$1,212.25" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200219 EAP HCPCS C1756 Temporary Pace Eletrode Cathet BOTH IP/OP $591.00 $437.34 $0.00 $472.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $438.64 $438.64 $455.54 $0.00 $123.16 $0.00 $0.00 $0.00 $0.00 $295.50 $468.07 $472.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200220 EAP HCPCS C1727 "Balloon Cutting Ultra Tube, 2." BOTH IP/OP "$2,574.00 " "$1,904.76" $0.00 "$2,059.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,910.42" "$1,910.42" "$1,984.04" $0.00 $536.42 $0.00 $0.00 $0.00 $0.00 "$1,287.00" "$2,038.61" "$2,059.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200226 EAP HCPCS C1725 4.00 X 15mm Voyager Rx Balloon BOTH IP/OP $699.00 $517.26 $0.00 $559.20 $379.56 $379.56 $0.00 $0.00 $0.00 $145.69 $518.80 $518.80 $538.79 $0.00 $145.67 $0.00 $413.46 $413.46 $0.00 $349.50 $553.61 $559.20 $0.00 $0.00 $0.00 $109.39 $0.00 $0.00 $111.28 $0.00 $0.00 $0.00 $0.00 $0.00 27200227 EAP HCPCS C1769 190cm All-star Guidewire BOTH IP/OP $288.00 $213.12 $0.00 $230.40 $156.38 $156.38 $0.00 $0.00 $0.00 $60.03 $213.75 $213.75 $221.99 $0.00 $60.02 $0.00 $170.35 $170.35 $0.00 $144.00 $228.10 $230.40 $0.00 $0.00 $0.00 $45.07 $0.00 $0.00 $45.85 $0.00 $0.00 $0.00 $0.00 $0.00 27200228 EAP HCPCS C1769 Choice X-support Guidewire BOTH IP/OP $605.00 $447.70 $0.00 $484.00 $328.52 $328.52 $0.00 $0.00 $0.00 $126.10 $449.03 $449.03 $466.33 $0.00 $126.08 $0.00 $357.86 $357.86 $0.00 $302.50 $479.16 $484.00 $0.00 $0.00 $0.00 $94.68 $0.00 $0.00 $96.32 $0.00 $0.00 $0.00 $0.00 $0.00 27200229 EAP HCPCS C1769 Choice Standard Guidewire BOTH IP/OP $605.00 $447.70 $0.00 $484.00 $328.52 $328.52 $0.00 $0.00 $0.00 $126.10 $449.03 $449.03 $466.33 $0.00 $126.08 $0.00 $357.86 $357.86 $0.00 $302.50 $479.16 $484.00 $0.00 $0.00 $0.00 $94.68 $0.00 $0.00 $96.32 $0.00 $0.00 $0.00 $0.00 $0.00 27200230 EAP HCPCS C1887 7fr Xb 3.0 Sh Guiding Cath BOTH IP/OP $199.00 $147.26 $0.00 $159.20 $108.06 $108.06 $0.00 $0.00 $0.00 $41.48 $147.70 $147.70 $153.39 $0.00 $41.47 $0.00 $117.71 $117.71 $0.00 $99.50 $157.61 $159.20 $0.00 $0.00 $0.00 $31.14 $0.00 $0.00 $31.68 $0.00 $0.00 $0.00 $0.00 $0.00 27200231 EAP HCPCS C1887 6fr Al 2 Guiding Cath BOTH IP/OP $161.00 $119.14 $0.00 $128.80 $87.42 $87.42 $0.00 $0.00 $0.00 $33.56 $119.49 $119.49 $124.10 $0.00 $33.55 $0.00 $95.23 $95.23 $0.00 $80.50 $127.51 $128.80 $0.00 $104.65 $0.00 $25.20 $0.00 $0.00 $25.63 $0.00 $0.00 $0.00 $0.00 $0.00 27200238 EAP HCPCS C1887 7fr Ar 2 Guiding Cath BOTH IP/OP $180.00 $133.20 $0.00 $144.00 $97.74 $97.74 $0.00 $0.00 $0.00 $37.52 $133.60 $133.60 $138.74 $0.00 $37.51 $0.00 $106.47 $106.47 $0.00 $90.00 $142.56 $144.00 $0.00 $0.00 $0.00 $28.17 $0.00 $0.00 $28.66 $0.00 $0.00 $0.00 $0.00 $0.00 27200239 EAP HCPCS C1887 7fr Jl3.5 Guiding Cath BOTH IP/OP $180.00 $133.20 $0.00 $144.00 $97.74 $97.74 $0.00 $0.00 $0.00 $37.52 $133.60 $133.60 $138.74 $0.00 $37.51 $0.00 $106.47 $106.47 $0.00 $90.00 $142.56 $144.00 $0.00 $0.00 $0.00 $28.17 $0.00 $0.00 $28.66 $0.00 $0.00 $0.00 $0.00 $0.00 27200247 EAP HCPCS C1887 7fr Lcb Guiding Cath BOTH IP/OP $199.00 $147.26 $0.00 $159.20 $108.06 $108.06 $0.00 $0.00 $0.00 $41.48 $147.70 $147.70 $153.39 $0.00 $41.47 $0.00 $117.71 $117.71 $0.00 $99.50 $157.61 $159.20 $0.00 $129.35 $0.00 $31.14 $0.00 $0.00 $31.68 $0.00 $0.00 $0.00 $0.00 $0.00 27200248 EAP HCPCS C1887 7fr Jr 4 Guiding Cath BOTH IP/OP $161.00 $119.14 $0.00 $128.80 $87.42 $87.42 $0.00 $0.00 $0.00 $33.56 $119.49 $119.49 $124.10 $0.00 $33.55 $0.00 $95.23 $95.23 $0.00 $80.50 $127.51 $128.80 $0.00 $104.65 $0.00 $25.20 $0.00 $0.00 $25.63 $0.00 $0.00 $0.00 $0.00 $0.00 27200249 EAP HCPCS C1887 7fr Ar 1 Guiding Cath BOTH IP/OP $161.00 $119.14 $0.00 $128.80 $87.42 $87.42 $0.00 $0.00 $0.00 $33.56 $119.49 $119.49 $124.10 $0.00 $33.55 $0.00 $95.23 $95.23 $0.00 $80.50 $127.51 $128.80 $0.00 $104.65 $0.00 $25.20 $0.00 $0.00 $25.63 $0.00 $0.00 $0.00 $0.00 $0.00 27200250 EAP HCPCS C1769 "Glide Wire,.035 Straight" BOTH IP/OP $112.00 $82.88 $0.00 $89.60 $60.82 $60.82 $0.00 $0.00 $0.00 $23.34 $83.13 $83.13 $86.33 $0.00 $23.34 $0.00 $66.25 $66.25 $0.00 $56.00 $88.70 $89.60 $0.00 $72.80 $0.00 $17.53 $0.00 $0.00 $17.83 $0.00 $0.00 $0.00 $0.00 $0.00 27200251 EAP HCPCS C1887 6fr Mpa- 1 Guiding Cath BOTH IP/OP $180.00 $133.20 $0.00 $144.00 $97.74 $97.74 $0.00 $0.00 $0.00 $37.52 $133.60 $133.60 $138.74 $0.00 $37.51 $0.00 $106.47 $106.47 $0.00 $90.00 $142.56 $144.00 $0.00 $0.00 $0.00 $28.17 $0.00 $0.00 $28.66 $0.00 $0.00 $0.00 $0.00 $0.00 27200252 EAP HCPCS C1769 190cm J Tip Bmw Guidewire BOTH IP/OP $348.00 $257.52 $0.00 $278.40 $188.96 $188.96 $0.00 $0.00 $0.00 $72.53 $258.29 $258.29 $268.24 $0.00 $72.52 $0.00 $205.84 $205.84 $0.00 $174.00 $275.62 $278.40 $0.00 $226.20 $0.00 $54.46 $0.00 $0.00 $55.40 $0.00 $0.00 $0.00 $0.00 $0.00 27200253 EAP HCPCS C1726 12frx28mmx70cm Inoue Balloon BOTH IP/OP "$19,725.00 " "$14,596.50" $0.00 "$15,780.00" "$10,710.68" "$10,710.68" $0.00 $0.00 $0.00 "$4,111.18" "$4,181.12" "$4,181.12" "$15,204.03" $0.00 "$4,110.69" $0.00 "$3,094.73" "$3,094.73" $0.00 "$9,862.50" "$15,622.20" "$15,780.00" $0.00 $0.00 $0.00 "$3,086.96" $0.00 $0.00 "$3,140.22" $0.00 $0.00 $0.00 $0.00 $0.00 27200254 EAP HCPCS C1887 6fr H Stick Sh Guiding Cathete BOTH IP/OP $161.00 $119.14 $0.00 $128.80 $87.42 $87.42 $0.00 $0.00 $0.00 $33.56 $119.49 $119.49 $124.10 $0.00 $33.55 $0.00 $95.23 $95.23 $0.00 $80.50 $127.51 $128.80 $0.00 $0.00 $0.00 $25.20 $0.00 $0.00 $25.63 $0.00 $0.00 $0.00 $0.00 $0.00 27200255 EAP HCPCS C1887 6fr Al 1 Sh Guiding Catheter BOTH IP/OP $161.00 $119.14 $0.00 $128.80 $87.42 $87.42 $0.00 $0.00 $0.00 $33.56 $119.49 $119.49 $124.10 $0.00 $33.55 $0.00 $95.23 $95.23 $0.00 $80.50 $127.51 $128.80 $0.00 $0.00 $0.00 $25.20 $0.00 $0.00 $25.63 $0.00 $0.00 $0.00 $0.00 $0.00 27200256 EAP HCPCS C1887 6fr Al 2 Sh Guiding Catheter BOTH IP/OP $161.00 $119.14 $0.00 $128.80 $87.42 $87.42 $0.00 $0.00 $0.00 $33.56 $119.49 $119.49 $124.10 $0.00 $33.55 $0.00 $95.23 $95.23 $0.00 $80.50 $127.51 $128.80 $0.00 $0.00 $0.00 $25.20 $0.00 $0.00 $25.63 $0.00 $0.00 $0.00 $0.00 $0.00 27200257 EAP HCPCS C1725 2.0 X 9mm Maverick Monorail BOTH IP/OP $916.00 $677.84 $0.00 $732.80 $497.39 $497.39 $0.00 $0.00 $0.00 $190.92 $679.86 $679.86 $706.05 $0.00 $190.89 $0.00 $541.81 $541.81 $0.00 $458.00 $725.47 $732.80 $0.00 $0.00 $0.00 $143.35 $0.00 $0.00 $145.83 $0.00 $0.00 $0.00 $0.00 $0.00 27200258 EAP HCPCS C1725 2.5 X 9mm Maverick Monorail BOTH IP/OP $916.00 $677.84 $0.00 $732.80 $497.39 $497.39 $0.00 $0.00 $0.00 $190.92 $679.86 $679.86 $706.05 $0.00 $190.89 $0.00 $541.81 $541.81 $0.00 $458.00 $725.47 $732.80 $0.00 $0.00 $0.00 $143.35 $0.00 $0.00 $145.83 $0.00 $0.00 $0.00 $0.00 $0.00 27200259 EAP HCPCS C1725 3.0 X 9mm Maverick Monorail BOTH IP/OP $872.00 $645.28 $0.00 $697.60 $473.50 $473.50 $0.00 $0.00 $0.00 $181.75 $647.20 $647.20 $672.14 $0.00 $181.72 $0.00 $515.79 $515.79 $0.00 $436.00 $690.62 $697.60 $0.00 $0.00 $0.00 $136.47 $0.00 $0.00 $138.82 $0.00 $0.00 $0.00 $0.00 $0.00 27200283 EAP HCPCS C1769 Hi-torque Pilot 50 Guide Wire BOTH IP/OP $302.00 $223.48 $0.00 $241.60 $163.99 $163.99 $0.00 $0.00 $0.00 $62.94 $224.14 $224.14 $232.78 $0.00 $62.94 $0.00 $178.63 $178.63 $0.00 $151.00 $239.18 $241.60 $0.00 $196.30 $0.00 $47.26 $0.00 $0.00 $48.08 $0.00 $0.00 $0.00 $0.00 $0.00 27200285 EAP HCPCS C1769 Doc Guide Wire Extension BOTH IP/OP $324.00 $239.76 $0.00 $259.20 $175.93 $175.93 $0.00 $0.00 $0.00 $67.53 $240.47 $240.47 $249.74 $0.00 $67.52 $0.00 $191.65 $191.65 $0.00 $162.00 $256.61 $259.20 $0.00 $210.60 $0.00 $50.71 $0.00 $0.00 $51.58 $0.00 $0.00 $0.00 $0.00 $0.00 27200292 EAP HCPCS C1725 1.5 X 6 Sprinter Balloon BOTH IP/OP $853.00 $631.22 $0.00 $682.40 $463.18 $463.18 $0.00 $0.00 $0.00 $177.79 $633.10 $633.10 $657.49 $0.00 $177.77 $0.00 $504.55 $504.55 $0.00 $426.50 $675.58 $682.40 $0.00 $0.00 $0.00 $133.49 $0.00 $0.00 $135.80 $0.00 $0.00 $0.00 $0.00 $0.00 27200294 EAP HCPCS C1751 7fr Wedge Pressure Cath BOTH IP/OP $153.00 $113.22 $0.00 $122.40 $83.08 $83.08 $0.00 $0.00 $0.00 $31.89 $113.56 $113.56 $117.93 $0.00 $31.89 $0.00 $90.50 $90.50 $0.00 $76.50 $121.18 $122.40 $0.00 $99.45 $0.00 $23.94 $0.00 $0.00 $24.36 $0.00 $0.00 $0.00 $0.00 $0.00 27200295 EAP Custom 27200295 Cardiac Cath Pack BOTH IP/OP $190.00 $140.60 $0.00 $152.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $141.02 $141.02 $146.45 $0.00 $39.60 $0.00 $0.00 $0.00 $0.00 $95.00 $150.48 $152.00 $0.00 $123.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200296 EAP Custom 27200296 Contrast Inject Line-low Press BOTH IP/OP $7.00 $5.18 $0.00 $5.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $5.20 $5.20 $5.40 $0.00 $1.46 $0.00 $0.00 $0.00 $0.00 $3.50 $5.54 $5.60 $0.00 $4.55 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200297 EAP Custom 27200297 Implant Tray BOTH IP/OP $212.00 $156.88 $0.00 $169.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $106.00 $167.90 $169.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200298 EAP HCPCS C1893 5fr - 10cm Pinnacle Introducer BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $20.63 $20.63 $0.00 $0.00 $0.00 $7.92 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $22.48 $22.48 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $5.95 $0.00 $0.00 $6.05 $0.00 $0.00 $0.00 $0.00 $0.00 27200299 EAP HCPCS C1893 6fr - 10cm Pinnacle Introducer BOTH IP/OP $40.00 $29.60 $0.00 $32.00 $21.72 $21.72 $0.00 $0.00 $0.00 $8.34 $29.69 $29.69 $30.83 $0.00 $8.34 $0.00 $23.66 $23.66 $0.00 $20.00 $31.68 $32.00 $0.00 $26.00 $0.00 $6.26 $0.00 $0.00 $6.37 $0.00 $0.00 $0.00 $0.00 $0.00 27200300 EAP HCPCS C1893 7fr - 10cm Pinnacle Introducer BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $20.63 $20.63 $0.00 $0.00 $0.00 $7.92 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $22.48 $22.48 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $5.95 $0.00 $0.00 $6.05 $0.00 $0.00 $0.00 $0.00 $0.00 27200301 EAP HCPCS C1893 8fr - 10cm Pinnacle Introducer BOTH IP/OP $38.00 $28.12 $0.00 $30.40 $20.63 $20.63 $0.00 $0.00 $0.00 $7.92 $28.20 $28.20 $29.29 $0.00 $7.92 $0.00 $22.48 $22.48 $0.00 $19.00 $30.10 $30.40 $0.00 $0.00 $0.00 $5.95 $0.00 $0.00 $6.05 $0.00 $0.00 $0.00 $0.00 $0.00 27200302 EAP HCPCS C1893 6fr - 25cm Pinnacle Introducer BOTH IP/OP $69.00 $51.06 $0.00 $55.20 $37.47 $37.47 $0.00 $0.00 $0.00 $14.38 $51.21 $51.21 $53.19 $0.00 $14.38 $0.00 $40.81 $40.81 $0.00 $34.50 $54.65 $55.20 $0.00 $0.00 $0.00 $10.80 $0.00 $0.00 $10.98 $0.00 $0.00 $0.00 $0.00 $0.00 27200303 EAP HCPCS C1893 7fr - 25cm Pinnacle Introducer BOTH IP/OP $69.00 $51.06 $0.00 $55.20 $37.47 $37.47 $0.00 $0.00 $0.00 $14.38 $51.21 $51.21 $53.19 $0.00 $14.38 $0.00 $40.81 $40.81 $0.00 $34.50 $54.65 $55.20 $0.00 $0.00 $0.00 $10.80 $0.00 $0.00 $10.98 $0.00 $0.00 $0.00 $0.00 $0.00 27200304 EAP HCPCS C1893 8fr - 25cm Pinnacle Introducer BOTH IP/OP $69.00 $51.06 $0.00 $55.20 $37.47 $37.47 $0.00 $0.00 $0.00 $14.38 $51.21 $51.21 $53.19 $0.00 $14.38 $0.00 $40.81 $40.81 $0.00 $34.50 $54.65 $55.20 $0.00 $0.00 $0.00 $10.80 $0.00 $0.00 $10.98 $0.00 $0.00 $0.00 $0.00 $0.00 27200305 EAP HCPCS C1887 6fr Ebu 3.0 Guiding Catheter BOTH IP/OP $189.00 $139.86 $0.00 $151.20 $102.63 $102.63 $0.00 $0.00 $0.00 $39.39 $140.28 $140.28 $145.68 $0.00 $39.39 $0.00 $111.79 $111.79 $0.00 $94.50 $149.69 $151.20 $0.00 $122.85 $0.00 $29.58 $0.00 $0.00 $30.09 $0.00 $0.00 $0.00 $0.00 $0.00 27200306 EAP HCPCS C1887 6fr Ebu 3.5 Guiding Catheter BOTH IP/OP $169.00 $125.06 $0.00 $135.20 $91.77 $91.77 $0.00 $0.00 $0.00 $35.22 $125.43 $125.43 $130.27 $0.00 $35.22 $0.00 $99.96 $99.96 $0.00 $84.50 $133.85 $135.20 $0.00 $109.85 $0.00 $26.45 $0.00 $0.00 $26.90 $0.00 $0.00 $0.00 $0.00 $0.00 27200307 EAP HCPCS C1887 6fr Ebu 4.0 Guiding Catheter BOTH IP/OP $169.00 $125.06 $0.00 $135.20 $91.77 $91.77 $0.00 $0.00 $0.00 $35.22 $125.43 $125.43 $130.27 $0.00 $35.22 $0.00 $99.96 $99.96 $0.00 $84.50 $133.85 $135.20 $0.00 $109.85 $0.00 $26.45 $0.00 $0.00 $26.90 $0.00 $0.00 $0.00 $0.00 $0.00 27200308 EAP HCPCS C1887 7fr Ebu 3.0 Guiding Catheter BOTH IP/OP $161.00 $119.14 $0.00 $128.80 $87.42 $87.42 $0.00 $0.00 $0.00 $33.56 $119.49 $119.49 $124.10 $0.00 $33.55 $0.00 $95.23 $95.23 $0.00 $80.50 $127.51 $128.80 $0.00 $104.65 $0.00 $25.20 $0.00 $0.00 $25.63 $0.00 $0.00 $0.00 $0.00 $0.00 27200309 EAP HCPCS C1887 7fr Ebu 3.5 Guiding Catheter BOTH IP/OP $161.00 $119.14 $0.00 $128.80 $87.42 $87.42 $0.00 $0.00 $0.00 $33.56 $119.49 $119.49 $124.10 $0.00 $33.55 $0.00 $95.23 $95.23 $0.00 $80.50 $127.51 $128.80 $0.00 $104.65 $0.00 $25.20 $0.00 $0.00 $25.63 $0.00 $0.00 $0.00 $0.00 $0.00 27200310 EAP HCPCS C1887 7fr Ebu 4.0 Guiding Catheter BOTH IP/OP $161.00 $119.14 $0.00 $128.80 $87.42 $87.42 $0.00 $0.00 $0.00 $33.56 $119.49 $119.49 $124.10 $0.00 $33.55 $0.00 $95.23 $95.23 $0.00 $80.50 $127.51 $128.80 $0.00 $104.65 $0.00 $25.20 $0.00 $0.00 $25.63 $0.00 $0.00 $0.00 $0.00 $0.00 27200311 EAP HCPCS C1887 8fr Ebu 3.5 Guiding Catheter BOTH IP/OP $180.00 $133.20 $0.00 $144.00 $97.74 $97.74 $0.00 $0.00 $0.00 $37.52 $133.60 $133.60 $138.74 $0.00 $37.51 $0.00 $106.47 $106.47 $0.00 $90.00 $142.56 $144.00 $0.00 $0.00 $0.00 $28.17 $0.00 $0.00 $28.66 $0.00 $0.00 $0.00 $0.00 $0.00 27200312 EAP HCPCS C1887 8fr Ebu 4.0 Guiding Catheter BOTH IP/OP $180.00 $133.20 $0.00 $144.00 $97.74 $97.74 $0.00 $0.00 $0.00 $37.52 $133.60 $133.60 $138.74 $0.00 $37.51 $0.00 $106.47 $106.47 $0.00 $90.00 $142.56 $144.00 $0.00 $0.00 $0.00 $28.17 $0.00 $0.00 $28.66 $0.00 $0.00 $0.00 $0.00 $0.00 27200313 EAP HCPCS C1727 3.0 X 10cm Cutting Balloon Otw BOTH IP/OP $986.00 $729.64 $0.00 $788.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $731.81 $731.81 $760.01 $0.00 $205.48 $0.00 $0.00 $0.00 $0.00 $493.00 $780.91 $788.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200314 EAP HCPCS C1757 7fr Export Xt Catheter BOTH IP/OP "$2,850.00 " "$2,109.00" $0.00 "$2,280.00" "$1,547.55" "$1,547.55" $0.00 $0.00 $0.00 $594.01 "$2,115.27" "$2,115.27" "$2,196.78" $0.00 $593.94 $0.00 "$1,685.78" "$1,685.78" $0.00 "$1,425.00" "$2,257.20" "$2,280.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200315 EAP HCPCS C1769 .014 - 300cm Asahi Miraclebros BOTH IP/OP $691.00 $511.34 $0.00 $552.80 $375.21 $375.21 $0.00 $0.00 $0.00 $144.02 $512.86 $512.86 $532.62 $0.00 $144.00 $0.00 $408.73 $408.73 $0.00 $345.50 $547.27 $552.80 $0.00 $449.15 $0.00 $108.14 $0.00 $0.00 $110.01 $0.00 $0.00 $0.00 $0.00 $0.00 27200316 EAP HCPCS C1769 .014 - 300cm Asahi Soft Wire BOTH IP/OP $268.00 $198.32 $0.00 $214.40 $145.52 $145.52 $0.00 $0.00 $0.00 $55.86 $198.91 $198.91 $206.57 $0.00 $55.85 $0.00 $158.52 $158.52 $0.00 $134.00 $212.26 $214.40 $0.00 $0.00 $0.00 $41.94 $0.00 $0.00 $42.67 $0.00 $0.00 $0.00 $0.00 $0.00 27200317 EAP HCPCS C1769 .014 - 300cm Whisper Ms BOTH IP/OP $331.00 $244.94 $0.00 $264.80 $179.73 $179.73 $0.00 $0.00 $0.00 $68.99 $245.67 $245.67 $255.13 $0.00 $68.98 $0.00 $195.79 $195.79 $0.00 $165.50 $262.15 $264.80 $0.00 $0.00 $0.00 $51.80 $0.00 $0.00 $52.70 $0.00 $0.00 $0.00 $0.00 $0.00 27200318 EAP HCPCS C1769 .014 - 300cm All-star Wire BOTH IP/OP $307.00 $227.18 $0.00 $245.60 $166.70 $166.70 $0.00 $0.00 $0.00 $63.99 $227.86 $227.86 $236.64 $0.00 $63.98 $0.00 $181.59 $181.59 $0.00 $153.50 $243.14 $245.60 $0.00 $199.55 $0.00 $48.05 $0.00 $0.00 $48.87 $0.00 $0.00 $0.00 $0.00 $0.00 27200319 EAP HCPCS C1753 Eagle Eye Coronary Imaging Cat BOTH IP/OP "$2,449.00 " "$1,812.26" $0.00 "$1,959.20" "$1,329.81" "$1,329.81" $0.00 $0.00 $0.00 $510.43 "$1,817.65" "$1,817.65" "$1,887.69" $0.00 $510.37 $0.00 "$1,448.58" "$1,448.58" $0.00 "$1,224.50" "$1,939.61" "$1,959.20" $0.00 "$1,591.85" $0.00 $383.27 $0.00 $0.00 $389.88 $0.00 $0.00 $0.00 $0.00 $0.00 27200320 EAP Custom 27200320 Primewire BOTH IP/OP "$2,332.00 " "$1,725.68" $0.00 "$1,865.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,730.81" "$1,730.81" "$1,797.51" $0.00 $485.99 $0.00 $0.00 $0.00 $0.00 "$1,166.00" "$1,846.94" "$1,865.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200321 EAP HCPCS C1893 8fr-35cm Super Arrow Flex Intr BOTH IP/OP $249.00 $184.26 $0.00 $199.20 $135.21 $135.21 $0.00 $0.00 $0.00 $51.90 $184.81 $184.81 $191.93 $0.00 $51.89 $0.00 $147.28 $147.28 $0.00 $124.50 $197.21 $199.20 $0.00 $0.00 $0.00 $38.97 $0.00 $0.00 $39.64 $0.00 $0.00 $0.00 $0.00 $0.00 27200322 EAP Custom 27200322 Platinum Plus St .018 Guidewir BOTH IP/OP $288.00 $213.12 $0.00 $230.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $213.75 $213.75 $221.99 $0.00 $60.02 $0.00 $0.00 $0.00 $0.00 $144.00 $228.10 $230.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200323 EAP Custom 27200323 Platinum Plus St .014 Guidewir BOTH IP/OP $288.00 $213.12 $0.00 $230.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $213.75 $213.75 $221.99 $0.00 $60.02 $0.00 $0.00 $0.00 $0.00 $144.00 $228.10 $230.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200324 EAP Custom 27200324 V-18 Control Wire BOTH IP/OP $340.00 $251.60 $0.00 $272.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $252.35 $252.35 $262.07 $0.00 $70.86 $0.00 $0.00 $0.00 $0.00 $170.00 $269.28 $272.00 $0.00 $221.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200325 EAP Custom 27200325 Steel Core 18 Guidewire BOTH IP/OP $64.00 $47.36 $0.00 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $47.50 $47.50 $49.33 $0.00 $13.34 $0.00 $0.00 $0.00 $0.00 $32.00 $50.69 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200329 EAP Custom 27200329 14fr Sheath Introducer BOTH IP/OP $87.00 $64.38 $0.00 $69.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $64.57 $64.57 $67.06 $0.00 $18.13 $0.00 $0.00 $0.00 $0.00 $43.50 $68.90 $69.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200338 EAP HCPCS C1725 Voyager Nc 2.5 X 15mm Balloon BOTH IP/OP $634.00 $469.16 $0.00 $507.20 $344.26 $344.26 $0.00 $0.00 $0.00 $132.14 $470.55 $470.55 $488.69 $0.00 $132.13 $0.00 $375.01 $375.01 $0.00 $317.00 $502.13 $507.20 $0.00 $412.10 $0.00 $99.22 $0.00 $0.00 $100.93 $0.00 $0.00 $0.00 $0.00 $0.00 27200373 EAP HCPCS C1726 Catheter Baldilat 12 Atm 1.5mm 142cm 12mm Rapex BOTH IP/OP $413.00 $305.62 $0.00 $330.40 $224.26 $224.26 $0.00 $0.00 $0.00 $86.08 $306.53 $306.53 $318.34 $0.00 $86.07 $0.00 $244.29 $244.29 $0.00 $206.50 $327.10 $330.40 $0.00 $268.45 $0.00 $64.63 $0.00 $0.00 $65.75 $0.00 $0.00 $0.00 $0.00 $0.00 27200376 EAP HCPCS C1726 Catheter Blndil 21cm .022in 2mm 142cm Lf 12mm Spntr Lgnd BOTH IP/OP $413.00 $305.62 $0.00 $330.40 $224.26 $224.26 $0.00 $0.00 $0.00 $86.08 $306.53 $306.53 $318.34 $0.00 $86.07 $0.00 $244.29 $244.29 $0.00 $206.50 $327.10 $330.40 $0.00 $268.45 $0.00 $64.63 $0.00 $0.00 $65.75 $0.00 $0.00 $0.00 $0.00 $0.00 27200382 EAP HCPCS C1726 Sprinter Legend Balloon Rx 3.0 BOTH IP/OP $569.00 $421.06 $0.00 $455.20 $308.97 $308.97 $0.00 $0.00 $0.00 $118.59 $422.31 $422.31 $438.59 $0.00 $118.58 $0.00 $336.56 $336.56 $0.00 $284.50 $450.65 $455.20 $0.00 $0.00 $0.00 $89.05 $0.00 $0.00 $90.58 $0.00 $0.00 $0.00 $0.00 $0.00 27200406 EAP HCPCS C1726 Sprinter Nc Balloon Rx 3.50x06 BOTH IP/OP $627.00 $463.98 $0.00 $501.60 $340.46 $340.46 $0.00 $0.00 $0.00 $130.68 $465.36 $465.36 $483.29 $0.00 $130.67 $0.00 $370.87 $370.87 $0.00 $313.50 $496.58 $501.60 $0.00 $0.00 $0.00 $98.13 $0.00 $0.00 $99.82 $0.00 $0.00 $0.00 $0.00 $0.00 27200408 EAP HCPCS C1726 Sprinter Nc Balloon Rx 3.50x12 BOTH IP/OP $627.00 $463.98 $0.00 $501.60 $340.46 $340.46 $0.00 $0.00 $0.00 $130.68 $465.36 $465.36 $483.29 $0.00 $130.67 $0.00 $370.87 $370.87 $0.00 $313.50 $496.58 $501.60 $0.00 $0.00 $0.00 $98.13 $0.00 $0.00 $99.82 $0.00 $0.00 $0.00 $0.00 $0.00 27200417 EAP HCPCS C1726 Sprinter Nc Balloon Rx 4.00x15 BOTH IP/OP $627.00 $463.98 $0.00 $501.60 $340.46 $340.46 $0.00 $0.00 $0.00 $130.68 $465.36 $465.36 $483.29 $0.00 $130.67 $0.00 $370.87 $370.87 $0.00 $313.50 $496.58 $501.60 $0.00 $0.00 $0.00 $98.13 $0.00 $0.00 $99.82 $0.00 $0.00 $0.00 $0.00 $0.00 27200422 EAP Custom 27200422 Spacer (mdi) BOTH IP/OP $215.00 $159.10 $0.00 $172.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $159.57 $159.57 $165.72 $0.00 $44.81 $0.00 $0.00 $0.00 $0.00 $107.50 $170.28 $172.00 $0.00 $139.75 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200423 EAP Custom 27200423 FOOT DROP SPLINT-CUSTOM BOTH IP/OP $243.00 $179.82 $0.00 $194.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $180.35 $180.35 $187.30 $0.00 $50.64 $0.00 $0.00 $0.00 $0.00 $121.50 $192.46 $194.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200425 EAP Custom 27200425 "Catheterization Kit, Straight" BOTH IP/OP $60.00 $44.40 $0.00 $48.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $44.53 $44.53 $46.25 $0.00 $12.50 $0.00 $0.00 $0.00 $0.00 $30.00 $47.52 $48.00 $0.00 $39.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200426 EAP Custom 27200426 Blood Administration Set Up BOTH IP/OP $3.00 $2.22 $0.00 $2.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $2.23 $2.23 $2.31 $0.00 $0.63 $0.00 $0.00 $0.00 $0.00 $1.50 $2.38 $2.40 $0.00 $1.95 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200427 EAP Custom 27200427 Intra-uterine Press Cath BOTH IP/OP $92.00 $68.08 $0.00 $73.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $68.28 $68.28 $70.91 $0.00 $19.17 $0.00 $0.00 $0.00 $0.00 $46.00 $72.86 $73.60 $0.00 $59.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200428 EAP Custom 27200428 "Pack, C-section" BOTH IP/OP $157.00 $116.18 $0.00 $125.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $116.53 $116.53 $121.02 $0.00 $32.72 $0.00 $0.00 $0.00 $0.00 $78.50 $124.34 $125.60 $0.00 $102.05 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200430 EAP Custom 27200430 "Catheterization Kit, Foley" BOTH IP/OP $64.00 $47.36 $0.00 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $47.50 $47.50 $49.33 $0.00 $13.34 $0.00 $0.00 $0.00 $0.00 $32.00 $50.69 $51.20 $0.00 $41.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200431 EAP Custom 27200431 "Catheterization Kit, Straight" BOTH IP/OP $180.00 $133.20 $0.00 $144.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $133.60 $133.60 $138.74 $0.00 $37.51 $0.00 $0.00 $0.00 $0.00 $90.00 $142.56 $144.00 $0.00 $117.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200432 EAP Custom 27200432 Blood Administration Set Up BOTH IP/OP $18.00 $13.32 $0.00 $14.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $13.36 $13.36 $13.87 $0.00 $3.75 $0.00 $0.00 $0.00 $0.00 $9.00 $14.26 $14.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200433 EAP Custom 27200433 Karmen Cannula BOTH IP/OP "$1,131.00 " $836.94 $0.00 $904.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $839.43 $839.43 $871.77 $0.00 $235.70 $0.00 $0.00 $0.00 $0.00 $565.50 $895.75 $904.80 $0.00 $735.15 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200434 EAP HCPCS A4405 Stomahesive Paste 2 Oz Tube BOTH IP/OP $108.00 $79.92 $0.00 $86.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $80.16 $80.16 $83.25 $0.00 $22.51 $0.00 $0.00 $0.00 $0.00 $54.00 $85.54 $86.40 $0.00 $70.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200435 EAP Custom 27200435 "Little Ones, Pouch Flange" BOTH IP/OP $18.00 $13.32 $0.00 $14.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $13.36 $13.36 $13.87 $0.00 $3.75 $0.00 $0.00 $0.00 $0.00 $9.00 $14.26 $14.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200436 EAP Custom 27200436 "Pouch, Urostomy Opaque" BOTH IP/OP $34.00 $25.16 $0.00 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $25.23 $25.23 $26.21 $0.00 $7.09 $0.00 $0.00 $0.00 $0.00 $17.00 $26.93 $27.20 $0.00 $22.10 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200437 EAP Custom 27200437 Flexible Flange BOTH IP/OP $42.00 $31.08 $0.00 $33.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $31.17 $31.17 $32.37 $0.00 $8.75 $0.00 $0.00 $0.00 $0.00 $21.00 $33.26 $33.60 $0.00 $27.30 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200438 EAP Custom 27200438 "Irrigator, Visiflow W/cone" BOTH IP/OP $201.00 $148.74 $0.00 $160.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $149.18 $149.18 $154.93 $0.00 $41.89 $0.00 $0.00 $0.00 $0.00 $100.50 $159.19 $160.80 $0.00 $130.65 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200439 EAP Custom 27200439 Irrigation Sleeve BOTH IP/OP $207.00 $153.18 $0.00 $165.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $153.64 $153.64 $159.56 $0.00 $43.14 $0.00 $0.00 $0.00 $0.00 $103.50 $163.94 $165.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200440 EAP HCPCS A4371 Stomahesive Powder BOTH IP/OP $56.00 $41.44 $0.00 $44.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $41.56 $41.56 $43.16 $0.00 $11.67 $0.00 $0.00 $0.00 $0.00 $28.00 $44.35 $44.80 $0.00 $36.40 $0.00 $8.76 $0.00 $0.00 $8.92 $0.00 $0.00 $0.00 $0.00 $0.00 27200441 EAP Custom 27200441 Mini Pouch BOTH IP/OP $56.00 $41.44 $0.00 $44.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $41.56 $41.56 $43.16 $0.00 $11.67 $0.00 $0.00 $0.00 $0.00 $28.00 $44.35 $44.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200442 EAP Custom 27200442 Wound Pouch Med. BOTH IP/OP $68.00 $50.32 $0.00 $54.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $50.47 $50.47 $52.41 $0.00 $14.17 $0.00 $0.00 $0.00 $0.00 $34.00 $53.86 $54.40 $0.00 $44.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200443 EAP HCPCS A4364 Medical Adhesive BOTH IP/OP $68.00 $50.32 $0.00 $54.40 $36.92 $36.92 $0.00 $0.00 $0.00 $14.17 $50.47 $50.47 $52.41 $0.00 $14.17 $0.00 $40.22 $40.22 $0.00 $34.00 $53.86 $54.40 $0.00 $44.20 $0.00 $10.64 $0.00 $0.00 $10.83 $0.00 $0.00 $0.00 $0.00 $0.00 27200444 EAP Custom 27200444 Drain Tube Attachment BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $0.00 $0.00 $0.00 $5.00 $7.92 $8.00 $0.00 $6.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200446 EAP HCPCS A4364 "Skin Bond Cement, 4oz" BOTH IP/OP $76.00 $56.24 $0.00 $60.80 $41.27 $41.27 $0.00 $0.00 $0.00 $15.84 $56.41 $56.41 $58.58 $0.00 $15.84 $0.00 $44.95 $44.95 $0.00 $38.00 $60.19 $60.80 $0.00 $0.00 $0.00 $11.89 $0.00 $0.00 $12.10 $0.00 $0.00 $0.00 $0.00 $0.00 27200447 EAP HCPCS A4455 "Uni-solve Wipes,adhes. Remover" BOTH IP/OP $103.00 $76.22 $0.00 $82.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $76.45 $76.45 $79.39 $0.00 $21.47 $0.00 $0.00 $0.00 $0.00 $51.50 $81.58 $82.40 $0.00 $66.95 $0.00 $16.12 $0.00 $0.00 $16.40 $0.00 $0.00 $0.00 $0.00 $0.00 27200448 EAP HCPCS A6197 Alginate Dressing>16<= 48 Sq In BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $0.00 $0.00 $0.00 $9.50 $15.05 $15.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200449 EAP Custom 27200449 Ace Wrap Supply BOTH IP/OP $34.00 $25.16 $0.00 $27.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $25.23 $25.23 $26.21 $0.00 $7.09 $0.00 $0.00 $0.00 $0.00 $17.00 $26.93 $27.20 $0.00 $22.10 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200450 EAP HCPCS C1728 "Catheter,brachytherapy Seed Ad" BOTH IP/OP "$10,554.00 " "$7,809.96" $0.00 "$8,443.20" "$5,730.82" "$5,730.82" $0.00 $0.00 $0.00 "$2,199.72" "$4,181.12" "$4,181.12" "$8,135.02" $0.00 "$2,199.45" $0.00 "$3,094.73" "$3,094.73" $0.00 "$5,277.00" "$8,358.77" "$8,443.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200452 EAP HCPCS C1757 Catheter 6fr X 65 Cm 9mm Cleaner Sterile BOTH IP/OP "$1,756.00 " "$1,299.44" $0.00 "$1,404.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $878.00 "$1,390.75" "$1,404.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200453 EAP HCPCS C1757 Catheter 6fr X 135 Cm 9mm Cleaner Sterile BOTH IP/OP "$2,351.00 " "$1,739.74" $0.00 "$1,880.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,175.50" "$1,861.99" "$1,880.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200454 EAP HCPCS C1757 Catheter 7 Fr X 65 Cm 9mm Cleaner Sterile BOTH IP/OP "$2,143.00 " "$1,585.82" $0.00 "$1,714.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,071.50" "$1,697.26" "$1,714.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200455 EAP HCPCS C1757 Catheter 7fr X 135 Cm 9mm Cleaner Sterile BOTH IP/OP "$2,660.00 " "$1,968.40" $0.00 "$2,128.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,330.00" "$2,106.72" "$2,128.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200456 EAP HCPCS C2629 Mic G-18 Introducer Kit BOTH IP/OP $585.00 $432.90 $0.00 $468.00 $0.00 $0.00 $0.00 $0.00 $0.00 $121.93 $434.19 $434.19 $450.92 $0.00 $121.91 $0.00 $346.03 $346.03 $0.00 $292.50 $463.32 $468.00 $0.00 $380.25 $0.00 $91.55 $0.00 $0.00 $93.13 $0.00 $0.00 $0.00 $0.00 $0.00 27200457 EAP HCPCS C1751 Cath Cen Ven 4fr 1 Lum Try 3cg Shrlk Sty Maximal Brr Pic BOTH IP/OP $249.00 $184.26 $0.00 $199.20 $135.21 $135.21 $0.00 $0.00 $0.00 $51.90 $184.81 $184.81 $191.93 $0.00 $51.89 $0.00 $147.28 $147.28 $0.00 $124.50 $197.21 $199.20 $0.00 $161.85 $0.00 $38.97 $0.00 $0.00 $39.64 $0.00 $0.00 $0.00 $0.00 $0.00 27200458 EAP HCPCS C1751 Cath 5fr 1lum Try 3cg Shrlk Sty Maximal Brr Picc P BOTH IP/OP $260.00 $192.40 $0.00 $208.00 $141.18 $141.18 $0.00 $0.00 $0.00 $54.19 $192.97 $192.97 $200.41 $0.00 $54.18 $0.00 $153.79 $153.79 $0.00 $130.00 $205.92 $208.00 $0.00 $169.00 $0.00 $40.69 $0.00 $0.00 $41.39 $0.00 $0.00 $0.00 $0.00 $0.00 27200459 EAP HCPCS C1751 Cath 6fr 1lum Try 3cg Shrlk Sty Maximal Brr Picc P BOTH IP/OP $260.00 $192.40 $0.00 $208.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $130.00 $205.92 $208.00 $0.00 $0.00 $0.00 $40.69 $0.00 $0.00 $41.39 $0.00 $0.00 $0.00 $0.00 $0.00 27200460 EAP HCPCS C1894 Micro Microintruducer 7cm 5.0fr Flecura Guidewire BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $21.18 $21.18 $0.00 $0.00 $0.00 $8.13 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $23.07 $23.07 $0.00 $19.50 $30.89 $31.20 $0.00 $25.35 $0.00 $6.10 $0.00 $0.00 $6.21 $0.00 $0.00 $0.00 $0.00 $0.00 27200461 EAP HCPCS C1751 Tray Cath 5fr 12cm Cen Ven Spctrm 3 Lum Pu .025in Disp D BOTH IP/OP $320.00 $236.80 $0.00 $256.00 $173.76 $173.76 $0.00 $0.00 $0.00 $66.70 $237.50 $237.50 $246.66 $0.00 $66.69 $0.00 $189.28 $189.28 $0.00 $160.00 $253.44 $256.00 $0.00 $0.00 $0.00 $50.08 $0.00 $0.00 $50.94 $0.00 $0.00 $0.00 $0.00 $0.00 27200462 EAP HCPCS C1887 Sheath Guid 65cm 6fr Pn Dstn .038in Str Hydphi BOTH IP/OP $224.00 $165.76 $0.00 $179.20 $121.63 $121.63 $0.00 $0.00 $0.00 $46.69 $166.25 $166.25 $172.66 $0.00 $46.68 $0.00 $132.50 $132.50 $0.00 $112.00 $177.41 $179.20 $0.00 $145.60 $0.00 $35.06 $0.00 $0.00 $35.66 $0.00 $0.00 $0.00 $0.00 $0.00 27200467 EAP HCPCS C1769 Guidewire Vascular Angle Standard .035in 180cm 3cm BOTH IP/OP $103.00 $76.22 $0.00 $82.40 $0.00 $0.00 $0.00 $0.00 $0.00 $21.47 $0.00 $0.00 $0.00 $0.00 $21.47 $0.00 $60.92 $60.92 $0.00 $51.50 $81.58 $82.40 $0.00 $0.00 $0.00 $16.12 $0.00 $0.00 $16.40 $0.00 $0.00 $0.00 $0.00 $0.00 27200470 EAP HCPCS C1884 Embosphere Pre-filled Syringe 300-500 Microns/2ml BOTH IP/OP $625.00 $462.50 $0.00 $500.00 $339.38 $339.38 $0.00 $0.00 $0.00 $130.27 $463.88 $463.88 $481.75 $0.00 $130.25 $0.00 $369.69 $369.69 $0.00 $312.50 $495.00 $500.00 $0.00 $406.25 $0.00 $97.81 $0.00 $0.00 $99.50 $0.00 $0.00 $0.00 $0.00 $0.00 27200471 EAP HCPCS C1894 Introducer Sheath 7fr .1in 80cm Tuohy Borst Sidearm Radiopq BOTH IP/OP $250.00 $185.00 $0.00 $200.00 $135.75 $135.75 $0.00 $0.00 $0.00 $52.11 $185.55 $185.55 $192.70 $0.00 $52.10 $0.00 $147.88 $147.88 $0.00 $125.00 $198.00 $200.00 $0.00 $162.50 $0.00 $39.13 $0.00 $0.00 $39.80 $0.00 $0.00 $0.00 $0.00 $0.00 27200472 EAP HCPCS C1769 Guidewire Vascular 45d .016in 180cm 2mm Angled Flexible Tip BOTH IP/OP $725.00 $536.50 $0.00 $580.00 $393.68 $393.68 $0.00 $0.00 $0.00 $151.11 $538.10 $538.10 $558.83 $0.00 $151.09 $0.00 $428.84 $428.84 $0.00 $362.50 $574.20 $580.00 $0.00 $0.00 $0.00 $113.46 $0.00 $0.00 $115.42 $0.00 $0.00 $0.00 $0.00 $0.00 27200473 EAP HCPCS C1887 Catheter Guid Mpc Curve 5fr .056in 90cm Braid Radiopq Soft BOTH IP/OP $893.00 $660.82 $0.00 $714.40 $484.90 $484.90 $0.00 $0.00 $0.00 $186.12 $662.78 $662.78 $688.32 $0.00 $186.10 $0.00 $528.21 $528.21 $0.00 $446.50 $707.26 $714.40 $0.00 $580.45 $0.00 $139.75 $0.00 $0.00 $142.17 $0.00 $0.00 $0.00 $0.00 $0.00 27200474 EAP HCPCS C1725 Catheter Angiographic Motarjeme Curve 5fr .046in 100cm Braid BOTH IP/OP $310.00 $229.40 $0.00 $238.95 $168.33 $168.33 $0.00 $0.00 $0.00 $64.61 $230.08 $230.08 $238.95 $0.00 $64.60 $0.00 $183.37 $183.37 $0.00 $15.50 $24.55 $24.80 $0.00 $201.50 $0.00 $4.85 $0.00 $0.00 $4.94 $0.00 $0.00 $0.00 $0.00 $0.00 27200475 EAP HCPCS C1725 Catheter Angiographic .035in Pigtail 5fr .052in 90cm Ultra BOTH IP/OP $305.00 $225.70 $0.00 $244.00 $165.62 $165.62 $0.00 $0.00 $0.00 $63.57 $226.37 $226.37 $235.09 $0.00 $63.56 $0.00 $180.41 $180.41 $0.00 $152.50 $241.56 $244.00 $0.00 $198.25 $0.00 $47.73 $0.00 $0.00 $48.56 $0.00 $0.00 $0.00 $0.00 $0.00 27200476 EAP HCPCS C1769 Guidewire Vascular Str .018in 180cm 25cm Shapeable Shaft BOTH IP/OP $398.00 $294.52 $0.00 $318.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $199.00 $315.22 $318.40 $0.00 $0.00 $0.00 $62.29 $0.00 $0.00 $63.36 $0.00 $0.00 $0.00 $0.00 $0.00 27200477 EAP HCPCS C1769 Guidewire Vascular .014in 300cm 20cm Exchange Radiopq Distal BOTH IP/OP $896.00 $663.04 $0.00 $716.80 $486.53 $486.53 $0.00 $0.00 $0.00 $186.75 $665.01 $665.01 $690.64 $0.00 $186.73 $0.00 $529.98 $529.98 $0.00 $448.00 $709.63 $716.80 $0.00 $582.40 $0.00 $140.22 $0.00 $0.00 $142.64 $0.00 $0.00 $0.00 $0.00 $0.00 27200478 EAP HCPCS C1887 Catheter Infus 45d .014in Micro Str 1.9-2.4fr .017in 155cm BOTH IP/OP "$1,773.00 " "$1,312.02" $0.00 "$1,418.40" $962.74 $962.74 $0.00 $0.00 $0.00 $369.54 "$1,315.92" "$1,315.92" "$1,366.63" $0.00 $369.49 $0.00 "$1,048.73" "$1,048.73" $0.00 $886.50 "$1,404.22" "$1,418.40" $0.00 $0.00 $0.00 $277.47 $0.00 $0.00 $282.26 $0.00 $0.00 $0.00 $0.00 $0.00 27200479 EAP HCPCS C1887 Catheter Infus 90d .014in Micro Str 1.9-2.4fr .017in 155cm BOTH IP/OP "$1,688.00 " "$1,249.12" $0.00 "$1,350.40" $916.58 $916.58 $0.00 $0.00 $0.00 $351.82 "$1,252.83" "$1,252.83" "$1,301.11" $0.00 $351.78 $0.00 $998.45 $998.45 $0.00 $844.00 "$1,336.90" "$1,350.40" $0.00 "$1,097.20" $0.00 $264.17 $0.00 $0.00 $268.73 $0.00 $0.00 $0.00 $0.00 $0.00 27200481 EAP Custom 27200481 Catheter Vascular Occlusion 1028 Flocontrol Tn BOTH IP/OP "$6,988.00 " "$5,171.12" $0.00 "$5,590.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,386.35" $0.00 "$1,456.30" $0.00 $0.00 $0.00 $0.00 "$3,494.00" "$5,534.50" "$5,590.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200482 EAP HCPCS C1757 Catheter Reperfusion 4max BOTH IP/OP "$3,225.00 " "$2,386.50" $0.00 "$2,580.00" "$1,751.18" "$1,751.18" $0.00 $0.00 $0.00 $672.17 "$2,393.60" "$2,393.60" "$2,485.83" $0.00 $672.09 $0.00 "$1,907.59" "$1,907.59" $0.00 "$1,612.50" "$2,554.20" "$2,580.00" $0.00 "$2,096.25" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200484 EAP Custom 27200484 Adhesive Ostomy Med Remain Flexible Silicone BOTH IP/OP $45.00 $33.30 $0.00 $36.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $33.40 $33.40 $34.69 $0.00 $9.38 $0.00 $0.00 $0.00 $0.00 $22.50 $35.64 $36.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200485 EAP HCPCS C1887 Catheter Guid 9fr Balloon Cello BOTH IP/OP "$1,875.00 " "$1,387.50" $0.00 "$1,500.00" "$1,018.13" "$1,018.13" $0.00 $0.00 $0.00 $390.80 "$1,391.63" "$1,391.63" "$1,445.25" $0.00 $390.75 $0.00 "$1,109.06" "$1,109.06" $0.00 $937.50 "$1,485.00" "$1,500.00" $0.00 $0.00 $0.00 $293.44 $0.00 $0.00 $298.50 $0.00 $0.00 $0.00 $0.00 $0.00 27200496 EAP HCPCS C1894 Introducer Sheath .035in 7fr .1in 70cm Anl1 Curve BOTH IP/OP $163.00 $120.62 $0.00 $130.40 $88.51 $88.51 $0.00 $0.00 $0.00 $33.97 $120.98 $120.98 $125.64 $0.00 $33.97 $0.00 $96.41 $96.41 $0.00 $81.50 $129.10 $130.40 $0.00 $105.95 $0.00 $25.51 $0.00 $0.00 $25.95 $0.00 $0.00 $0.00 $0.00 $0.00 27200714 EAP Custom 27200714 Compression Hose Lg/xlg Knee BOTH IP/OP $131.00 $96.94 $0.00 $104.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $97.23 $97.23 $100.97 $0.00 $27.30 $0.00 $0.00 $0.00 $0.00 $65.50 $103.75 $104.80 $0.00 $85.15 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200751 EAP Custom 27200751 "Grasping Forceps, 10mm X 120cm" BOTH IP/OP $744.00 $550.56 $0.00 $595.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $552.20 $552.20 $573.48 $0.00 $155.05 $0.00 $0.00 $0.00 $0.00 $372.00 $589.25 $595.20 $0.00 $483.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200753 EAP Custom 27200753 "Grasping Forceps, 8mm X 120cm" BOTH IP/OP $708.00 $523.92 $0.00 $566.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $525.48 $525.48 $545.73 $0.00 $147.55 $0.00 $0.00 $0.00 $0.00 $354.00 $560.74 $566.40 $0.00 $460.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200755 EAP Custom 27200755 "Grasp Forceps, Stone Retrieval" BOTH IP/OP $705.00 $521.70 $0.00 $564.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $523.25 $523.25 $543.41 $0.00 $146.92 $0.00 $0.00 $0.00 $0.00 $352.50 $558.36 $564.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200766 EAP Custom 27200766 "Probe, Electrohydraulic Lithot" BOTH IP/OP $428.00 $316.72 $0.00 $342.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $317.66 $317.66 $329.90 $0.00 $89.20 $0.00 $0.00 $0.00 $0.00 $214.00 $338.98 $342.40 $0.00 $278.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200769 EAP Custom 27200769 Bipolar Forceps BOTH IP/OP $573.00 $424.02 $0.00 $458.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $425.28 $425.28 $441.67 $0.00 $119.41 $0.00 $0.00 $0.00 $0.00 $286.50 $453.82 $458.40 $0.00 $372.45 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27200834 EAP Custom 27200834 Wet Field Cautery BOTH IP/OP $136.00 $100.64 $0.00 $108.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $100.94 $100.94 $104.83 $0.00 $28.34 $0.00 $0.00 $0.00 $0.00 $68.00 $107.71 $108.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201077 EAP HCPCS C1769 "Guide Wire, 292.653" BOTH IP/OP $183.00 $135.42 $0.00 $146.40 $99.37 $99.37 $0.00 $0.00 $0.00 $38.14 $135.82 $135.82 $141.06 $0.00 $38.14 $0.00 $108.24 $108.24 $0.00 $91.50 $144.94 $146.40 $0.00 $0.00 $0.00 $28.64 $0.00 $0.00 $29.13 $0.00 $0.00 $0.00 $0.00 $0.00 27201301 EAP Custom 27201301 "Drill Bit, 357.047" BOTH IP/OP "$1,952.00 " "$1,444.48" $0.00 "$1,561.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,448.77" "$1,448.77" "$1,504.60" $0.00 $406.80 $0.00 $0.00 $0.00 $0.00 $976.00 "$1,545.98" "$1,561.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201369 EAP Custom 27201369 Endo Disposable Lap. Instr. BOTH IP/OP $977.00 $722.98 $0.00 $781.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $725.13 $725.13 $753.07 $0.00 $203.61 $0.00 $0.00 $0.00 $0.00 $488.50 $773.78 $781.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201377 EAP Custom 27201377 Ta Premium Dlu Staples BOTH IP/OP "$1,093.00 " $808.82 $0.00 $874.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $811.22 $811.22 $842.48 $0.00 $227.78 $0.00 $0.00 $0.00 $0.00 $546.50 $865.66 $874.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201399 EAP Custom 27201399 Bipolar Bovie BOTH IP/OP $14.00 $10.36 $0.00 $11.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $10.39 $10.39 $10.79 $0.00 $2.92 $0.00 $0.00 $0.00 $0.00 $7.00 $11.09 $11.20 $0.00 $9.10 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201400 EAP Custom 27201400 Micro Clips BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $25.35 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201403 EAP Custom 27201403 Abd Binder BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $25.35 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201407 EAP Custom 27201407 Dermabond BOTH IP/OP $87.00 $64.38 $0.00 $69.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $64.57 $64.57 $67.06 $0.00 $18.13 $0.00 $0.00 $0.00 $0.00 $43.50 $68.90 $69.60 $0.00 $56.55 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201456 EAP Custom 27201456 "Grasping Forceps, 10mm X 120cm" BOTH IP/OP $744.00 $550.56 $0.00 $595.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $552.20 $552.20 $573.48 $0.00 $155.05 $0.00 $0.00 $0.00 $0.00 $372.00 $589.25 $595.20 $0.00 $483.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201458 EAP Custom 27201458 "Grasping Forceps, Stone Retrie" BOTH IP/OP $705.00 $521.70 $0.00 $564.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $523.25 $523.25 $543.41 $0.00 $146.92 $0.00 $0.00 $0.00 $0.00 $352.50 $558.36 $564.00 $0.00 $458.25 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201474 EAP Custom 27201474 "Grasping Forceps, 8mm X 120cm" BOTH IP/OP $707.00 $523.18 $0.00 $565.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $524.74 $524.74 $544.96 $0.00 $147.34 $0.00 $0.00 $0.00 $0.00 $353.50 $559.94 $565.60 $0.00 $459.55 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201489 EAP Custom 27201489 Irrigation Clip BOTH IP/OP $214.00 $158.36 $0.00 $171.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $158.83 $158.83 $164.95 $0.00 $44.60 $0.00 $0.00 $0.00 $0.00 $107.00 $169.49 $171.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201492 EAP Custom 27201492 Jp Drain (hemaduct) BOTH IP/OP $90.00 $66.60 $0.00 $72.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $66.80 $66.80 $69.37 $0.00 $18.76 $0.00 $0.00 $0.00 $0.00 $45.00 $71.28 $72.00 $0.00 $58.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201536 EAP Custom 27201536 Compression Hose Reg. Knee BOTH IP/OP $101.00 $74.74 $0.00 $80.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $74.96 $74.96 $77.85 $0.00 $21.05 $0.00 $0.00 $0.00 $0.00 $50.50 $79.99 $80.80 $0.00 $65.65 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201626 EAP Custom 27201626 "Cath,intra-aortic Balloon" BOTH IP/OP "$4,716.00 " "$3,489.84" $0.00 "$3,772.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,358.00" "$3,735.07" "$3,772.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201630 EAP Custom 27201630 "Cath,chest Tube Rt. Angled" BOTH IP/OP $135.00 $99.90 $0.00 $108.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $100.20 $100.20 $104.06 $0.00 $28.13 $0.00 $0.00 $0.00 $0.00 $67.50 $106.92 $108.00 $0.00 $87.75 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201680 EAP Custom 27201680 Catheter Angio .038in Ka2 Crv 5fr .046in 40cm Impr BOTH IP/OP $165.00 $122.10 $0.00 $132.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $34.39 $0.00 $0.00 $0.00 $0.00 $82.50 $130.68 $132.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201681 EAP Custom 27201681 Catheter Angio .038in Ka2 Crv 5fr .046in 65cm Prfm BOTH IP/OP $153.00 $113.22 $0.00 $122.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $113.56 $113.56 $117.93 $0.00 $31.89 $0.00 $0.00 $0.00 $0.00 $76.50 $121.18 $122.40 $0.00 $99.45 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201700 EAP Custom 27201700 Rbc Filter Unit BOTH IP/OP $83.00 $61.42 $0.00 $66.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $61.60 $61.60 $63.98 $0.00 $17.30 $0.00 $0.00 $0.00 $0.00 $41.50 $65.74 $66.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201701 EAP Custom 27201701 Plat Filter Unit BOTH IP/OP $215.00 $159.10 $0.00 $172.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $159.57 $159.57 $165.72 $0.00 $44.81 $0.00 $0.00 $0.00 $0.00 $107.50 $170.28 $172.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201702 EAP Custom 27201702 Plf1 Filter Unit BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $0.00 $0.00 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201800 EAP HCPCS C1729 Catheter Foley 16fr BOTH IP/OP $6.00 $4.44 $0.00 $4.80 $3.26 $3.26 $0.00 $0.00 $0.00 $1.25 $4.45 $4.45 $4.62 $0.00 $1.25 $0.00 $3.55 $3.55 $0.00 $3.00 $4.75 $4.80 $0.00 $0.00 $0.00 $0.94 $0.00 $0.00 $0.96 $0.00 $0.00 $0.00 $0.00 $0.00 27201801 EAP HCPCS C1769 Guidewire .35x150cm Bentson BOTH IP/OP $76.00 $56.24 $0.00 $60.80 $41.27 $41.27 $0.00 $0.00 $0.00 $15.84 $56.41 $56.41 $58.58 $0.00 $15.84 $0.00 $44.95 $44.95 $0.00 $38.00 $60.19 $60.80 $0.00 $49.40 $0.00 $11.89 $0.00 $0.00 $12.10 $0.00 $0.00 $0.00 $0.00 $0.00 27201802 EAP HCPCS C1750 24cm Duraflow Catheter BOTH IP/OP "$2,096.00 " "$1,551.04" $0.00 "$1,676.80" "$1,138.13" "$1,138.13" $0.00 $0.00 $0.00 $436.86 "$1,555.65" "$1,555.65" "$1,615.60" $0.00 $436.81 $0.00 "$1,239.78" "$1,239.78" $0.00 "$1,048.00" "$1,660.03" "$1,676.80" $0.00 $0.00 $0.00 $328.02 $0.00 $0.00 $333.68 $0.00 $0.00 $0.00 $0.00 $0.00 27201803 EAP HCPCS C1750 28cm Duraflow Catheter BOTH IP/OP "$1,720.00 " "$1,272.80" $0.00 "$1,376.00" $933.96 $933.96 $0.00 $0.00 $0.00 $358.49 "$1,276.58" "$1,276.58" "$1,325.78" $0.00 $358.45 $0.00 "$1,017.38" "$1,017.38" $0.00 $860.00 "$1,362.24" "$1,376.00" $0.00 $0.00 $0.00 $269.18 $0.00 $0.00 $273.82 $0.00 $0.00 $0.00 $0.00 $0.00 27201804 EAP HCPCS C1752 24cm Schon Xl Temp Cath BOTH IP/OP $315.00 $233.10 $0.00 $252.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $233.79 $233.79 $242.80 $0.00 $65.65 $0.00 $0.00 $0.00 $0.00 $157.50 $249.48 $252.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201805 EAP HCPCS C1751 5x1235x20cm Unifuse Kit BOTH IP/OP $550.00 $407.00 $0.00 $440.00 $298.65 $298.65 $0.00 $0.00 $0.00 $114.63 $408.21 $408.21 $423.94 $0.00 $114.62 $0.00 $325.33 $325.33 $0.00 $275.00 $435.60 $440.00 $0.00 $357.50 $0.00 $86.08 $0.00 $0.00 $87.56 $0.00 $0.00 $0.00 $0.00 $0.00 27201806 EAP HCPCS C1751 5x135x10cm Unifuse Kit BOTH IP/OP $550.00 $407.00 $0.00 $440.00 $298.65 $298.65 $0.00 $0.00 $0.00 $114.63 $408.21 $408.21 $423.94 $0.00 $114.62 $0.00 $325.33 $325.33 $0.00 $275.00 $435.60 $440.00 $0.00 $357.50 $0.00 $86.08 $0.00 $0.00 $87.56 $0.00 $0.00 $0.00 $0.00 $0.00 27201807 EAP HCPCS C1725 8-4/5/75 Workhorse Pta BOTH IP/OP $438.00 $324.12 $0.00 $350.40 $237.83 $237.83 $0.00 $0.00 $0.00 $91.29 $325.08 $325.08 $337.61 $0.00 $91.28 $0.00 $259.08 $259.08 $0.00 $219.00 $346.90 $350.40 $0.00 $0.00 $0.00 $68.55 $0.00 $0.00 $69.73 $0.00 $0.00 $0.00 $0.00 $0.00 27201808 EAP HCPCS C1752 Temporary Dialysis Cath BOTH IP/OP $315.00 $233.10 $0.00 $252.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $233.79 $233.79 $242.80 $0.00 $65.65 $0.00 $0.00 $0.00 $0.00 $157.50 $249.48 $252.00 $0.00 $204.75 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201809 EAP HCPCS C1752 Temporay Dialysis Cath BOTH IP/OP $740.00 $547.60 $0.00 $592.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $549.23 $549.23 $570.39 $0.00 $154.22 $0.00 $0.00 $0.00 $0.00 $370.00 $586.08 $592.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201810 EAP HCPCS C1725 Workhorse Pta Balloon BOTH IP/OP $438.00 $324.12 $0.00 $350.40 $237.83 $237.83 $0.00 $0.00 $0.00 $91.29 $325.08 $325.08 $337.61 $0.00 $91.28 $0.00 $259.08 $259.08 $0.00 $219.00 $346.90 $350.40 $0.00 $0.00 $0.00 $68.55 $0.00 $0.00 $69.73 $0.00 $0.00 $0.00 $0.00 $0.00 27201811 EAP HCPCS C1725 Workhorse Pta Balloon BOTH IP/OP $438.00 $324.12 $0.00 $350.40 $237.83 $237.83 $0.00 $0.00 $0.00 $91.29 $325.08 $325.08 $337.61 $0.00 $91.28 $0.00 $259.08 $259.08 $0.00 $219.00 $346.90 $350.40 $0.00 $0.00 $0.00 $68.55 $0.00 $0.00 $69.73 $0.00 $0.00 $0.00 $0.00 $0.00 27201812 EAP HCPCS C1725 Wrkhorse Balloon 5-2/5/75 BOTH IP/OP $438.00 $324.12 $0.00 $350.40 $237.83 $237.83 $0.00 $0.00 $0.00 $91.29 $325.08 $325.08 $337.61 $0.00 $91.28 $0.00 $259.08 $259.08 $0.00 $219.00 $346.90 $350.40 $0.00 $0.00 $0.00 $68.55 $0.00 $0.00 $69.73 $0.00 $0.00 $0.00 $0.00 $0.00 27201813 EAP HCPCS C1725 Wrkhrse Balloon 10-4/5/75 BOTH IP/OP $438.00 $324.12 $0.00 $350.40 $237.83 $237.83 $0.00 $0.00 $0.00 $91.29 $325.08 $325.08 $337.61 $0.00 $91.28 $0.00 $259.08 $259.08 $0.00 $219.00 $346.90 $350.40 $0.00 $0.00 $0.00 $68.55 $0.00 $0.00 $69.73 $0.00 $0.00 $0.00 $0.00 $0.00 27201814 EAP HCPCS C1725 Wrkhrse Balloon 5-2/5/100 BOTH IP/OP $438.00 $324.12 $0.00 $350.40 $237.83 $237.83 $0.00 $0.00 $0.00 $91.29 $325.08 $325.08 $337.61 $0.00 $91.28 $0.00 $259.08 $259.08 $0.00 $219.00 $346.90 $350.40 $0.00 $0.00 $0.00 $68.55 $0.00 $0.00 $69.73 $0.00 $0.00 $0.00 $0.00 $0.00 27201815 EAP HCPCS C1725 Wrkhrse Balloon 6-2/5/75 BOTH IP/OP $438.00 $324.12 $0.00 $350.40 $237.83 $237.83 $0.00 $0.00 $0.00 $91.29 $325.08 $325.08 $337.61 $0.00 $91.28 $0.00 $259.08 $259.08 $0.00 $219.00 $346.90 $350.40 $0.00 $0.00 $0.00 $68.55 $0.00 $0.00 $69.73 $0.00 $0.00 $0.00 $0.00 $0.00 27201816 EAP HCPCS C1751 5fr Dual Lumen Picc Line BOTH IP/OP $533.00 $394.42 $0.00 $426.40 $289.42 $289.42 $0.00 $0.00 $0.00 $111.09 $395.59 $395.59 $410.84 $0.00 $111.08 $0.00 $315.27 $315.27 $0.00 $266.50 $422.14 $426.40 $0.00 $0.00 $0.00 $83.41 $0.00 $0.00 $84.85 $0.00 $0.00 $0.00 $0.00 $0.00 27201817 EAP HCPCS C1751 5fr Sgle Lumen Pic Line BOTH IP/OP $419.00 $310.06 $0.00 $335.20 $227.52 $227.52 $0.00 $0.00 $0.00 $87.33 $310.98 $310.98 $322.97 $0.00 $87.32 $0.00 $247.84 $247.84 $0.00 $209.50 $331.85 $335.20 $0.00 $0.00 $0.00 $65.57 $0.00 $0.00 $66.70 $0.00 $0.00 $0.00 $0.00 $0.00 27201818 EAP HCPCS C1757 Thrombex Device BOTH IP/OP "$5,955.00 " "$4,406.70" $0.00 "$4,764.00" "$3,233.57" "$3,233.57" $0.00 $0.00 $0.00 "$1,241.17" "$4,181.12" "$4,181.12" "$4,590.11" $0.00 "$1,241.02" $0.00 "$3,094.73" "$3,094.73" $0.00 "$2,977.50" "$4,716.36" "$4,764.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201819 EAP HCPCS C1769 Guidewire .035/260m Exchange BOTH IP/OP $149.00 $110.26 $0.00 $119.20 $80.91 $80.91 $0.00 $0.00 $0.00 $31.06 $110.59 $110.59 $114.85 $0.00 $31.05 $0.00 $88.13 $88.13 $0.00 $74.50 $118.01 $119.20 $0.00 $96.85 $0.00 $23.32 $0.00 $0.00 $23.72 $0.00 $0.00 $0.00 $0.00 $0.00 27201820 EAP HCPCS C1769 Guidewire .035-150cm Angled Stiff BOTH IP/OP $167.00 $123.58 $0.00 $133.60 $90.68 $90.68 $0.00 $0.00 $0.00 $34.81 $123.95 $123.95 $128.72 $0.00 $34.80 $0.00 $98.78 $98.78 $0.00 $83.50 $132.26 $133.60 $0.00 $108.55 $0.00 $26.14 $0.00 $0.00 $26.59 $0.00 $0.00 $0.00 $0.00 $0.00 27201821 EAP HCPCS C1751 12cm Katzen Infusion Cath BOTH IP/OP "$1,506.00 " "$1,114.44" $0.00 "$1,204.80" $817.76 $817.76 $0.00 $0.00 $0.00 $313.89 "$1,117.75" "$1,117.75" "$1,160.82" $0.00 $313.85 $0.00 $890.80 $890.80 $0.00 $753.00 "$1,192.75" "$1,204.80" $0.00 $0.00 $0.00 $235.69 $0.00 $0.00 $239.76 $0.00 $0.00 $0.00 $0.00 $0.00 27201822 EAP HCPCS C1751 150/20 Tracker-18 Infusio BOTH IP/OP "$3,033.00 " "$2,244.42" $0.00 "$2,426.40" "$1,646.92" "$1,646.92" $0.00 $0.00 $0.00 $632.15 "$2,251.09" "$2,251.09" "$2,337.84" $0.00 $632.08 $0.00 "$1,794.02" "$1,794.02" $0.00 "$1,516.50" "$2,402.14" "$2,426.40" $0.00 $0.00 $0.00 $474.66 $0.00 $0.00 $482.85 $0.00 $0.00 $0.00 $0.00 $0.00 27201823 EAP HCPCS C1769 32-150 Angled Guidewire BOTH IP/OP $287.00 $212.38 $0.00 $229.60 $155.84 $155.84 $0.00 $0.00 $0.00 $59.82 $213.01 $213.01 $221.22 $0.00 $59.81 $0.00 $169.76 $169.76 $0.00 $143.50 $227.30 $229.60 $0.00 $0.00 $0.00 $44.92 $0.00 $0.00 $45.69 $0.00 $0.00 $0.00 $0.00 $0.00 27201824 EAP HCPCS C1894 5fr Pinnacle Introducer BOTH IP/OP $67.00 $49.58 $0.00 $53.60 $36.38 $36.38 $0.00 $0.00 $0.00 $13.96 $49.73 $49.73 $51.64 $0.00 $13.96 $0.00 $39.63 $39.63 $0.00 $33.50 $53.06 $53.60 $0.00 $0.00 $0.00 $10.49 $0.00 $0.00 $10.67 $0.00 $0.00 $0.00 $0.00 $0.00 27201825 EAP HCPCS C1887 5fr-100cm At Catheter BOTH IP/OP $37.00 $27.38 $0.00 $29.60 $20.09 $20.09 $0.00 $0.00 $0.00 $7.71 $27.46 $27.46 $28.52 $0.00 $7.71 $0.00 $21.89 $21.89 $0.00 $18.50 $29.30 $29.60 $0.00 $24.05 $0.00 $5.79 $0.00 $0.00 $5.89 $0.00 $0.00 $0.00 $0.00 $0.00 27201826 EAP HCPCS C1751 A50/20 Fastracker-18 Infu BOTH IP/OP "$1,590.00 " "$1,176.60" $0.00 "$1,272.00" $863.37 $863.37 $0.00 $0.00 $0.00 $331.40 "$1,180.10" "$1,180.10" "$1,225.57" $0.00 $331.36 $0.00 $940.49 $940.49 $0.00 $795.00 "$1,259.28" "$1,272.00" $0.00 $0.00 $0.00 $248.84 $0.00 $0.00 $253.13 $0.00 $0.00 $0.00 $0.00 $0.00 27201827 EAP HCPCS C1769 Amplatz Guidewire 260cm BOTH IP/OP $129.00 $95.46 $0.00 $103.20 $70.05 $70.05 $0.00 $0.00 $0.00 $26.89 $95.74 $95.74 $99.43 $0.00 $26.88 $0.00 $76.30 $76.30 $0.00 $64.50 $102.17 $103.20 $0.00 $83.85 $0.00 $20.19 $0.00 $0.00 $20.54 $0.00 $0.00 $0.00 $0.00 $0.00 27201828 EAP HCPCS C1725 Catheter Balloon 6-10/5 BOTH IP/OP $681.00 $503.94 $0.00 $544.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $340.50 $539.35 $544.80 $0.00 $0.00 $0.00 $106.58 $0.00 $0.00 $108.42 $0.00 $0.00 $0.00 $0.00 $0.00 27201829 EAP HCPCS C1887 Glidecath C2 Hydeophilic BOTH IP/OP $175.00 $129.50 $0.00 $140.00 $95.03 $95.03 $0.00 $0.00 $0.00 $36.47 $129.89 $129.89 $134.89 $0.00 $36.47 $0.00 $103.51 $103.51 $0.00 $87.50 $138.60 $140.00 $0.00 $113.75 $0.00 $27.39 $0.00 $0.00 $27.86 $0.00 $0.00 $0.00 $0.00 $0.00 27201830 EAP HCPCS C1769 Glidewire .035 150cm Angled BOTH IP/OP $101.00 $74.74 $0.00 $80.80 $54.84 $54.84 $0.00 $0.00 $0.00 $21.05 $74.96 $74.96 $77.85 $0.00 $21.05 $0.00 $59.74 $59.74 $0.00 $50.50 $79.99 $80.80 $0.00 $0.00 $0.00 $15.81 $0.00 $0.00 $16.08 $0.00 $0.00 $0.00 $0.00 $0.00 27201831 EAP HCPCS C1769 Guidewire Amplatz Super BOTH IP/OP $425.00 $314.50 $0.00 $340.00 $230.78 $230.78 $0.00 $0.00 $0.00 $88.58 $315.44 $315.44 $327.59 $0.00 $88.57 $0.00 $251.39 $251.39 $0.00 $212.50 $336.60 $340.00 $0.00 $276.25 $0.00 $66.51 $0.00 $0.00 $67.66 $0.00 $0.00 $0.00 $0.00 $0.00 27201832 EAP HCPCS C1769 Guidewire-long Taper BOTH IP/OP $313.00 $231.62 $0.00 $250.40 $169.96 $169.96 $0.00 $0.00 $0.00 $65.24 $232.31 $232.31 $241.26 $0.00 $65.23 $0.00 $185.14 $185.14 $0.00 $156.50 $247.90 $250.40 $0.00 $0.00 $0.00 $48.98 $0.00 $0.00 $49.83 $0.00 $0.00 $0.00 $0.00 $0.00 27201833 EAP HCPCS C1769 Transcend Steerable BOTH IP/OP $546.00 $404.04 $0.00 $533.60 $296.48 $296.48 $0.00 $0.00 $0.00 $113.80 $405.24 $405.24 $420.86 $0.00 $113.79 $0.00 $322.96 $322.96 $0.00 $333.50 $528.26 $533.60 $0.00 $354.90 $0.00 $104.39 $0.00 $0.00 $106.19 $0.00 $0.00 $0.00 $0.00 $0.00 27201834 EAP HCPCS C1725 Xxl 14-4/5.8/120 BOTH IP/OP $856.00 $633.44 $0.00 $684.80 $464.81 $464.81 $0.00 $0.00 $0.00 $178.41 $635.32 $635.32 $659.80 $0.00 $178.39 $0.00 $506.32 $506.32 $0.00 $428.00 $677.95 $684.80 $0.00 $0.00 $0.00 $133.96 $0.00 $0.00 $136.28 $0.00 $0.00 $0.00 $0.00 $0.00 27201835 EAP HCPCS C1725 Xxl/12-5/5.8/120 Balloon BOTH IP/OP $856.00 $633.44 $0.00 $684.80 $464.81 $464.81 $0.00 $0.00 $0.00 $178.41 $635.32 $635.32 $659.80 $0.00 $178.39 $0.00 $506.32 $506.32 $0.00 $428.00 $677.95 $684.80 $0.00 $0.00 $0.00 $133.96 $0.00 $0.00 $136.28 $0.00 $0.00 $0.00 $0.00 $0.00 27201836 EAP HCPCS C1769 Guidewire .035-260cm Bentson E BOTH IP/OP $88.00 $65.12 $0.00 $70.40 $47.78 $47.78 $0.00 $0.00 $0.00 $18.34 $65.31 $65.31 $67.83 $0.00 $18.34 $0.00 $52.05 $52.05 $0.00 $44.00 $69.70 $70.40 $0.00 $57.20 $0.00 $13.77 $0.00 $0.00 $14.01 $0.00 $0.00 $0.00 $0.00 $0.00 27201837 EAP HCPCS C1729 10.2fr Mp Drain Catheter BOTH IP/OP $296.00 $219.04 $0.00 $236.80 $160.73 $160.73 $0.00 $0.00 $0.00 $61.69 $219.69 $219.69 $228.16 $0.00 $61.69 $0.00 $175.08 $175.08 $0.00 $148.00 $234.43 $236.80 $0.00 $192.40 $0.00 $46.32 $0.00 $0.00 $47.12 $0.00 $0.00 $0.00 $0.00 $0.00 27201838 EAP HCPCS C1894 11fr-70cm Introducer Set BOTH IP/OP $233.00 $172.42 $0.00 $186.40 $126.52 $126.52 $0.00 $0.00 $0.00 $48.56 $172.93 $172.93 $179.60 $0.00 $48.56 $0.00 $137.82 $137.82 $0.00 $116.50 $184.54 $186.40 $0.00 $151.45 $0.00 $36.46 $0.00 $0.00 $37.09 $0.00 $0.00 $0.00 $0.00 $0.00 27201839 EAP HCPCS C1729 14.0fr Mp Drain Catheter BOTH IP/OP $289.00 $213.86 $0.00 $231.20 $156.93 $156.93 $0.00 $0.00 $0.00 $60.23 $214.50 $214.50 $222.76 $0.00 $60.23 $0.00 $170.94 $170.94 $0.00 $144.50 $228.89 $231.20 $0.00 $0.00 $0.00 $45.23 $0.00 $0.00 $46.01 $0.00 $0.00 $0.00 $0.00 $0.00 27201840 EAP Custom 27201840 35-3-5 Embolization Coil BOTH IP/OP $172.00 $127.28 $0.00 $137.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $127.66 $127.66 $132.58 $0.00 $35.84 $0.00 $0.00 $0.00 $0.00 $86.00 $136.22 $137.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201841 EAP Custom 27201841 35-5-10 Embolization Coil BOTH IP/OP $279.00 $206.46 $0.00 $223.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $207.07 $207.07 $215.05 $0.00 $58.14 $0.00 $0.00 $0.00 $0.00 $139.50 $220.97 $223.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201842 EAP Custom 27201842 35-5-3 Embolization Coil BOTH IP/OP $228.00 $168.72 $0.00 $182.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $169.22 $169.22 $175.74 $0.00 $47.52 $0.00 $0.00 $0.00 $0.00 $114.00 $180.58 $182.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201843 EAP Custom 27201843 35-5-8 Embolization Coil BOTH IP/OP $167.00 $123.58 $0.00 $133.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $123.95 $123.95 $128.72 $0.00 $34.80 $0.00 $0.00 $0.00 $0.00 $83.50 $132.26 $133.60 $0.00 $75.15 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201844 EAP HCPCS C1893 5fr80cm Neff Catheter BOTH IP/OP $120.00 $88.80 $0.00 $96.00 $65.16 $65.16 $0.00 $0.00 $0.00 $25.01 $89.06 $89.06 $92.50 $0.00 $25.01 $0.00 $70.98 $70.98 $0.00 $60.00 $95.04 $96.00 $0.00 $0.00 $0.00 $18.78 $0.00 $0.00 $19.10 $0.00 $0.00 $0.00 $0.00 $0.00 27201845 EAP HCPCS C1894 6fr Balkan Introducer Set BOTH IP/OP $60.00 $44.40 $0.00 $48.00 $32.58 $32.58 $0.00 $0.00 $0.00 $12.51 $44.53 $44.53 $46.25 $0.00 $12.50 $0.00 $35.49 $35.49 $0.00 $30.00 $47.52 $48.00 $0.00 $39.00 $0.00 $9.39 $0.00 $0.00 $9.55 $0.00 $0.00 $0.00 $0.00 $0.00 27201846 EAP HCPCS C1894 7fr Balkan Introducer Set BOTH IP/OP $170.00 $125.80 $0.00 $136.00 $92.31 $92.31 $0.00 $0.00 $0.00 $35.43 $126.17 $126.17 $131.04 $0.00 $35.43 $0.00 $100.56 $100.56 $0.00 $85.00 $134.64 $136.00 $0.00 $0.00 $0.00 $26.61 $0.00 $0.00 $27.06 $0.00 $0.00 $0.00 $0.00 $0.00 27201847 EAP HCPCS C1729 8.5fr Mp Drain Catheter BOTH IP/OP $311.00 $230.14 $0.00 $248.80 $168.87 $168.87 $0.00 $0.00 $0.00 $64.82 $230.82 $230.82 $239.72 $0.00 $64.81 $0.00 $183.96 $183.96 $0.00 $155.50 $246.31 $248.80 $0.00 $202.15 $0.00 $48.67 $0.00 $0.00 $49.51 $0.00 $0.00 $0.00 $0.00 $0.00 27201848 EAP HCPCS C1729 9.5fr Biliary Drain Cath. BOTH IP/OP $296.00 $219.04 $0.00 $236.80 $160.73 $160.73 $0.00 $0.00 $0.00 $61.69 $219.69 $219.69 $228.16 $0.00 $61.69 $0.00 $175.08 $175.08 $0.00 $148.00 $234.43 $236.80 $0.00 $192.40 $0.00 $46.32 $0.00 $0.00 $47.12 $0.00 $0.00 $0.00 $0.00 $0.00 27201849 EAP HCPCS C1757 Coil Embolization 35-4-3 BOTH IP/OP $172.00 $127.28 $0.00 $137.60 $93.40 $93.40 $0.00 $0.00 $0.00 $35.85 $127.66 $127.66 $132.58 $0.00 $35.84 $0.00 $101.74 $101.74 $0.00 $86.00 $136.22 $137.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201850 EAP HCPCS C1769 Dtdw35-80-10 Deflecting BOTH IP/OP $520.00 $384.80 $0.00 $416.00 $282.36 $282.36 $0.00 $0.00 $0.00 $108.38 $385.94 $385.94 $400.82 $0.00 $108.37 $0.00 $307.58 $307.58 $0.00 $260.00 $411.84 $416.00 $0.00 $0.00 $0.00 $81.38 $0.00 $0.00 $82.78 $0.00 $0.00 $0.00 $0.00 $0.00 27201851 EAP HCPCS C1773 Filter Retrieval Set BOTH IP/OP $886.00 $655.64 $0.00 $708.80 $481.10 $481.10 $0.00 $0.00 $0.00 $184.66 $657.59 $657.59 $682.93 $0.00 $184.64 $0.00 $524.07 $524.07 $0.00 $443.00 $701.71 $708.80 $0.00 $575.90 $0.00 $138.66 $0.00 $0.00 $141.05 $0.00 $0.00 $0.00 $0.00 $0.00 27201852 EAP HCPCS C1769 Guidewire Cope Mandril BOTH IP/OP $116.00 $85.84 $0.00 $92.80 $62.99 $62.99 $0.00 $0.00 $0.00 $24.18 $86.10 $86.10 $89.41 $0.00 $24.17 $0.00 $68.61 $68.61 $0.00 $58.00 $91.87 $92.80 $0.00 $75.40 $0.00 $18.15 $0.00 $0.00 $18.47 $0.00 $0.00 $0.00 $0.00 $0.00 27201853 EAP HCPCS C1769 Lewis Micropunture Set BOTH IP/OP $130.00 $96.20 $0.00 $104.00 $70.59 $70.59 $0.00 $0.00 $0.00 $27.10 $96.49 $96.49 $100.20 $0.00 $27.09 $0.00 $76.90 $76.90 $0.00 $65.00 $102.96 $104.00 $0.00 $84.50 $0.00 $20.35 $0.00 $0.00 $20.70 $0.00 $0.00 $0.00 $0.00 $0.00 27201854 EAP HCPCS C2629 Micropuncture Set BOTH IP/OP $102.00 $75.48 $0.00 $81.60 $0.00 $0.00 $0.00 $0.00 $0.00 $21.26 $75.70 $75.70 $78.62 $0.00 $21.26 $0.00 $60.33 $60.33 $0.00 $51.00 $80.78 $81.60 $0.00 $66.30 $0.00 $15.96 $0.00 $0.00 $16.24 $0.00 $0.00 $0.00 $0.00 $0.00 27201855 EAP HCPCS C1894 8fr-23cmavanti-introducer BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $5.43 $5.43 $0.00 $0.00 $0.00 $2.08 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $5.92 $5.92 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $1.57 $0.00 $0.00 $1.59 $0.00 $0.00 $0.00 $0.00 $0.00 27201856 EAP HCPCS C1894 9fr-23cm Avanti Introduce BOTH IP/OP $10.00 $7.40 $0.00 $8.00 $5.43 $5.43 $0.00 $0.00 $0.00 $2.08 $7.42 $7.42 $7.71 $0.00 $2.08 $0.00 $5.92 $5.92 $0.00 $5.00 $7.92 $8.00 $0.00 $0.00 $0.00 $1.57 $0.00 $0.00 $1.59 $0.00 $0.00 $0.00 $0.00 $0.00 27201857 EAP HCPCS C1773 12-20mmx120cm Std Snare BOTH IP/OP "$1,119.00 " $828.06 $0.00 $895.20 $607.62 $607.62 $0.00 $0.00 $0.00 $233.23 $830.52 $830.52 $862.53 $0.00 $233.20 $0.00 $661.89 $661.89 $0.00 $559.50 $886.25 $895.20 $0.00 $727.35 $0.00 $175.12 $0.00 $0.00 $178.14 $0.00 $0.00 $0.00 $0.00 $0.00 27201858 EAP HCPCS C1773 9-15mmx120cm Std Snare BOTH IP/OP "$1,119.00 " $828.06 $0.00 $895.20 $607.62 $607.62 $0.00 $0.00 $0.00 $233.23 $830.52 $830.52 $862.53 $0.00 $233.20 $0.00 $661.89 $661.89 $0.00 $559.50 $886.25 $895.20 $0.00 $727.35 $0.00 $175.12 $0.00 $0.00 $178.14 $0.00 $0.00 $0.00 $0.00 $0.00 27201859 EAP HCPCS C1725 Wrkhorse Balloon 10-4/5/100 BOTH IP/OP $438.00 $324.12 $0.00 $350.40 $237.83 $237.83 $0.00 $0.00 $0.00 $91.29 $325.08 $325.08 $337.61 $0.00 $91.28 $0.00 $259.08 $259.08 $0.00 $219.00 $346.90 $350.40 $0.00 $0.00 $0.00 $68.55 $0.00 $0.00 $69.73 $0.00 $0.00 $0.00 $0.00 $0.00 27201860 EAP HCPCS C1894 Pinnacle Introducer 5fr 10cm BOTH IP/OP $80.00 $59.20 $0.00 $64.00 $43.44 $43.44 $0.00 $0.00 $0.00 $16.67 $59.38 $59.38 $61.66 $0.00 $16.67 $0.00 $47.32 $47.32 $0.00 $40.00 $63.36 $64.00 $0.00 $52.00 $0.00 $12.52 $0.00 $0.00 $12.74 $0.00 $0.00 $0.00 $0.00 $0.00 27201861 EAP HCPCS C1725 Conquest Pta Balloon Dilatatio BOTH IP/OP $753.00 $557.22 $0.00 $602.40 $408.88 $408.88 $0.00 $0.00 $0.00 $156.94 $558.88 $558.88 $580.41 $0.00 $156.93 $0.00 $445.40 $445.40 $0.00 $376.50 $596.38 $602.40 $0.00 $489.45 $0.00 $117.84 $0.00 $0.00 $119.88 $0.00 $0.00 $0.00 $0.00 $0.00 27201862 EAP HCPCS C1725 Opti-plast Balloon Dilatation BOTH IP/OP $501.00 $370.74 $0.00 $400.80 $272.04 $272.04 $0.00 $0.00 $0.00 $104.42 $371.84 $371.84 $386.17 $0.00 $104.41 $0.00 $296.34 $296.34 $0.00 $250.50 $396.79 $400.80 $0.00 $0.00 $0.00 $78.41 $0.00 $0.00 $79.76 $0.00 $0.00 $0.00 $0.00 $0.00 27201863 EAP HCPCS C1725 Workhorse Pta Workhorse Balloo BOTH IP/OP $438.00 $324.12 $0.00 $350.40 $237.83 $237.83 $0.00 $0.00 $0.00 $91.29 $325.08 $325.08 $337.61 $0.00 $91.28 $0.00 $259.08 $259.08 $0.00 $219.00 $346.90 $350.40 $0.00 $0.00 $0.00 $68.55 $0.00 $0.00 $69.73 $0.00 $0.00 $0.00 $0.00 $0.00 27201864 EAP HCPCS C1769 Guidewire Straight Fixed Core BOTH IP/OP $86.00 $63.64 $0.00 $68.80 $46.70 $46.70 $0.00 $0.00 $0.00 $17.92 $63.83 $63.83 $66.29 $0.00 $17.92 $0.00 $50.87 $50.87 $0.00 $43.00 $68.11 $68.80 $0.00 $0.00 $0.00 $13.46 $0.00 $0.00 $13.69 $0.00 $0.00 $0.00 $0.00 $0.00 27201865 EAP HCPCS C1769 Guidewire 3mm J Fixed Core .03 BOTH IP/OP $46.00 $34.04 $0.00 $36.80 $24.98 $24.98 $0.00 $0.00 $0.00 $9.59 $34.14 $34.14 $35.46 $0.00 $9.59 $0.00 $27.21 $27.21 $0.00 $23.00 $36.43 $36.80 $0.00 $29.90 $0.00 $7.20 $0.00 $0.00 $7.32 $0.00 $0.00 $0.00 $0.00 $0.00 27201866 EAP HCPCS C1894 Pinnacle Introducer 6fr 10cm BOTH IP/OP $76.00 $56.24 $0.00 $60.80 $41.27 $41.27 $0.00 $0.00 $0.00 $15.84 $56.41 $56.41 $58.58 $0.00 $15.84 $0.00 $44.95 $44.95 $0.00 $38.00 $60.19 $60.80 $0.00 $0.00 $0.00 $11.89 $0.00 $0.00 $12.10 $0.00 $0.00 $0.00 $0.00 $0.00 27201867 EAP HCPCS C1894 8fr 10cm Pinnacle Introducer BOTH IP/OP $72.00 $53.28 $0.00 $57.60 $39.10 $39.10 $0.00 $0.00 $0.00 $15.01 $53.44 $53.44 $55.50 $0.00 $15.00 $0.00 $42.59 $42.59 $0.00 $36.00 $57.02 $57.60 $0.00 $46.80 $0.00 $11.27 $0.00 $0.00 $11.46 $0.00 $0.00 $0.00 $0.00 $0.00 27201868 EAP HCPCS C1894 Pinnacle Introducer 8fr 10cm BOTH IP/OP $67.00 $49.58 $0.00 $53.60 $36.38 $36.38 $0.00 $0.00 $0.00 $13.96 $49.73 $49.73 $51.64 $0.00 $13.96 $0.00 $39.63 $39.63 $0.00 $33.50 $53.06 $53.60 $0.00 $0.00 $0.00 $10.49 $0.00 $0.00 $10.67 $0.00 $0.00 $0.00 $0.00 $0.00 27201869 EAP HCPCS C1894 Pinnacle Introducer 9fr 10cm BOTH IP/OP $80.00 $59.20 $0.00 $64.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $40.00 $63.36 $64.00 $0.00 $0.00 $0.00 $12.52 $0.00 $0.00 $12.74 $0.00 $0.00 $0.00 $0.00 $0.00 27201870 EAP HCPCS C1757 Fogarty 5.5-40cm BOTH IP/OP $352.00 $260.48 $0.00 $281.60 $191.14 $191.14 $0.00 $0.00 $0.00 $73.37 $261.25 $261.25 $271.32 $0.00 $73.36 $0.00 $208.21 $208.21 $0.00 $176.00 $278.78 $281.60 $0.00 $228.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201871 EAP HCPCS C1757 Fogarty 5.5 80cm BOTH IP/OP $352.00 $260.48 $0.00 $281.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $176.00 $278.78 $281.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201872 EAP HCPCS C1757 Arrow Trerotola Thromolytic De BOTH IP/OP "$1,805.00 " "$1,335.70" $0.00 "$1,444.00" $980.12 $980.12 $0.00 $0.00 $0.00 $376.21 "$1,339.67" "$1,339.67" "$1,391.29" $0.00 $376.16 $0.00 "$1,067.66" "$1,067.66" $0.00 $902.50 "$1,429.56" "$1,444.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201873 EAP HCPCS C1757 Complex Fiber Coil 18 X 3mm X BOTH IP/OP "$1,212.00 " $896.88 $0.00 $969.60 $658.12 $658.12 $0.00 $0.00 $0.00 $252.61 $899.55 $899.55 $934.21 $0.00 $252.58 $0.00 $716.90 $716.90 $0.00 $606.00 $959.90 $969.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201874 EAP HCPCS C1729 Skater 10fr BOTH IP/OP $605.00 $447.70 $0.00 $484.00 $328.52 $328.52 $0.00 $0.00 $0.00 $126.10 $449.03 $449.03 $466.33 $0.00 $126.08 $0.00 $357.86 $357.86 $0.00 $302.50 $479.16 $484.00 $0.00 $0.00 $0.00 $94.68 $0.00 $0.00 $96.32 $0.00 $0.00 $0.00 $0.00 $0.00 27201875 EAP HCPCS C1887 Lima Guiding Catheter 7fr-55cm BOTH IP/OP $417.00 $308.58 $0.00 $333.60 $226.43 $226.43 $0.00 $0.00 $0.00 $86.91 $309.50 $309.50 $321.42 $0.00 $86.90 $0.00 $246.66 $246.66 $0.00 $208.50 $330.26 $333.60 $0.00 $0.00 $0.00 $65.26 $0.00 $0.00 $66.39 $0.00 $0.00 $0.00 $0.00 $0.00 27201876 EAP HCPCS C1892 Meditech Accustick Ii Introduc BOTH IP/OP $209.00 $154.66 $0.00 $167.20 $113.49 $113.49 $0.00 $0.00 $0.00 $43.56 $155.12 $155.12 $161.10 $0.00 $43.56 $0.00 $123.62 $123.62 $0.00 $104.50 $165.53 $167.20 $0.00 $135.85 $0.00 $32.71 $0.00 $0.00 $33.27 $0.00 $0.00 $0.00 $0.00 $0.00 27201877 EAP HCPCS C1769 22g X 10cm Chiba Needle BOTH IP/OP $27.00 $19.98 $0.00 $56.00 $14.66 $14.66 $0.00 $0.00 $0.00 $5.63 $20.04 $20.04 $20.81 $0.00 $5.63 $0.00 $15.97 $15.97 $0.00 $35.00 $55.44 $56.00 $0.00 $0.00 $0.00 $10.96 $0.00 $0.00 $11.14 $0.00 $0.00 $0.00 $0.00 $0.00 27201878 EAP HCPCS C1769 .038-145 Amplatz Extra Stiff BOTH IP/OP $76.00 $56.24 $0.00 $60.80 $41.27 $41.27 $0.00 $0.00 $0.00 $15.84 $56.41 $56.41 $58.58 $0.00 $15.84 $0.00 $44.95 $44.95 $0.00 $38.00 $60.19 $60.80 $0.00 $49.40 $0.00 $11.89 $0.00 $0.00 $12.10 $0.00 $0.00 $0.00 $0.00 $0.00 27201879 EAP HCPCS C1751 9fr Single Lumen Hickman BOTH IP/OP $241.00 $178.34 $0.00 $192.80 $130.86 $130.86 $0.00 $0.00 $0.00 $50.23 $178.87 $178.87 $185.76 $0.00 $50.22 $0.00 $142.55 $142.55 $0.00 $120.50 $190.87 $192.80 $0.00 $156.65 $0.00 $37.72 $0.00 $0.00 $38.37 $0.00 $0.00 $0.00 $0.00 $0.00 27201880 EAP HCPCS C1751 9fr Dual Lumen Hickman BOTH IP/OP $528.00 $390.72 $0.00 $422.40 $286.70 $286.70 $0.00 $0.00 $0.00 $110.05 $391.88 $391.88 $406.98 $0.00 $110.04 $0.00 $312.31 $312.31 $0.00 $264.00 $418.18 $422.40 $0.00 $0.00 $0.00 $82.63 $0.00 $0.00 $84.06 $0.00 $0.00 $0.00 $0.00 $0.00 27201881 EAP HCPCS C1769 .035-150cm 3mm J Guidewire BOTH IP/OP $68.00 $50.32 $0.00 $54.40 $36.92 $36.92 $0.00 $0.00 $0.00 $14.17 $50.47 $50.47 $52.41 $0.00 $14.17 $0.00 $40.22 $40.22 $0.00 $34.00 $53.86 $54.40 $0.00 $44.20 $0.00 $10.64 $0.00 $0.00 $10.83 $0.00 $0.00 $0.00 $0.00 $0.00 27201882 EAP HCPCS C1769 .035-150cm Rosen Guidewire BOTH IP/OP $65.00 $48.10 $0.00 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $32.50 $51.48 $52.00 $0.00 $0.00 $0.00 $10.17 $0.00 $0.00 $10.35 $0.00 $0.00 $0.00 $0.00 $0.00 27201883 EAP HCPCS C1752 "12cm Niagra, Temp Dialysis Cat" BOTH IP/OP $150.00 $111.00 $0.00 $120.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $111.33 $111.33 $115.62 $0.00 $31.26 $0.00 $0.00 $0.00 $0.00 $75.00 $118.80 $120.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201884 EAP HCPCS C1752 "15cm Niagra, Temp Dialysis Cat" BOTH IP/OP $64.00 $47.36 $0.00 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $47.50 $47.50 $49.33 $0.00 $13.34 $0.00 $0.00 $0.00 $0.00 $32.00 $50.69 $51.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201885 EAP HCPCS C1725 8-2/5/100 Workhorse Balloon BOTH IP/OP $427.00 $315.98 $0.00 $341.60 $231.86 $231.86 $0.00 $0.00 $0.00 $89.00 $316.92 $316.92 $329.13 $0.00 $88.99 $0.00 $252.57 $252.57 $0.00 $213.50 $338.18 $341.60 $0.00 $0.00 $0.00 $66.83 $0.00 $0.00 $67.98 $0.00 $0.00 $0.00 $0.00 $0.00 27201886 EAP HCPCS C1725 4-2/5/75 Opti-plast Balloon BOTH IP/OP $501.00 $370.74 $0.00 $400.80 $272.04 $272.04 $0.00 $0.00 $0.00 $104.42 $371.84 $371.84 $386.17 $0.00 $104.41 $0.00 $296.34 $296.34 $0.00 $250.50 $396.79 $400.80 $0.00 $0.00 $0.00 $78.41 $0.00 $0.00 $79.76 $0.00 $0.00 $0.00 $0.00 $0.00 27201887 EAP HCPCS C1725 3-way Hp Stopcock BOTH IP/OP $934.00 $691.16 $0.00 $747.20 $507.16 $507.16 $0.00 $0.00 $0.00 $194.67 $693.21 $693.21 $719.93 $0.00 $194.65 $0.00 $552.46 $552.46 $0.00 $467.00 $739.73 $747.20 $0.00 $0.00 $0.00 $146.17 $0.00 $0.00 $148.69 $0.00 $0.00 $0.00 $0.00 $0.00 27201888 EAP HCPCS C1894 7fr 10cm Pinnacle Introducer BOTH IP/OP $71.00 $52.54 $0.00 $56.80 $38.55 $38.55 $0.00 $0.00 $0.00 $14.80 $52.70 $52.70 $54.73 $0.00 $14.80 $0.00 $42.00 $42.00 $0.00 $35.50 $56.23 $56.80 $0.00 $46.15 $0.00 $11.11 $0.00 $0.00 $11.30 $0.00 $0.00 $0.00 $0.00 $0.00 27201889 EAP HCPCS C1894 7fr 10cm Pinnacle Introducer BOTH IP/OP $135.00 $99.90 $0.00 $108.00 $73.31 $73.31 $0.00 $0.00 $0.00 $28.14 $100.20 $100.20 $104.06 $0.00 $28.13 $0.00 $79.85 $79.85 $0.00 $67.50 $106.92 $108.00 $0.00 $0.00 $0.00 $21.13 $0.00 $0.00 $21.49 $0.00 $0.00 $0.00 $0.00 $0.00 27201890 EAP HCPCS C1725 12-2/5.8/75 Udt Dilatation Bal BOTH IP/OP $889.00 $657.86 $0.00 $711.20 $482.73 $482.73 $0.00 $0.00 $0.00 $185.29 $659.82 $659.82 $685.24 $0.00 $185.27 $0.00 $525.84 $525.84 $0.00 $444.50 $704.09 $711.20 $0.00 $0.00 $0.00 $139.13 $0.00 $0.00 $141.53 $0.00 $0.00 $0.00 $0.00 $0.00 27201891 EAP HCPCS C1729 8fr Flexima Biliary Catheter BOTH IP/OP $271.00 $200.54 $0.00 $216.80 $147.15 $147.15 $0.00 $0.00 $0.00 $56.48 $201.14 $201.14 $208.89 $0.00 $56.48 $0.00 $160.30 $160.30 $0.00 $135.50 $214.63 $216.80 $0.00 $176.15 $0.00 $42.41 $0.00 $0.00 $43.14 $0.00 $0.00 $0.00 $0.00 $0.00 27201892 EAP HCPCS C1729 Cx 18.0-38-40-p-32s-bcl BOTH IP/OP $300.00 $222.00 $0.00 $240.00 $162.90 $162.90 $0.00 $0.00 $0.00 $62.53 $222.66 $222.66 $231.24 $0.00 $62.52 $0.00 $177.45 $177.45 $0.00 $150.00 $237.60 $240.00 $0.00 $0.00 $0.00 $46.95 $0.00 $0.00 $47.76 $0.00 $0.00 $0.00 $0.00 $0.00 27201893 EAP Custom 27201893 Tibia Fracture Brace BOTH IP/OP $485.00 $358.90 $0.00 $388.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $359.97 $359.97 $373.84 $0.00 $101.07 $0.00 $0.00 $0.00 $0.00 $242.50 $384.12 $388.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201905 EAP Custom 27201905 Scapel Surg W/handle Atta BOTH IP/OP $142.00 $105.08 $0.00 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $105.39 $105.39 $109.45 $0.00 $29.59 $0.00 $0.00 $0.00 $0.00 $71.00 $112.46 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201906 EAP HCPCS A6250 Wound Paste BOTH IP/OP $118.00 $87.32 $0.00 $94.40 $0.00 $0.00 $0.00 $0.00 $0.00 $24.59 $87.58 $87.58 $90.95 $0.00 $24.59 $0.00 $69.80 $69.80 $0.00 $59.00 $93.46 $94.40 $0.00 $76.70 $0.00 $18.47 $0.00 $0.00 $18.79 $0.00 $0.00 $0.00 $0.00 $0.00 27201914 EAP Custom 27201914 Scapel Surg W/handle Atta BOTH IP/OP $142.00 $105.08 $0.00 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $105.39 $105.39 $109.45 $0.00 $29.59 $0.00 $0.00 $0.00 $0.00 $71.00 $112.46 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27201930 EAP HCPCS C1729 Catheter Foley 5cc 14fr BOTH IP/OP $18.00 $13.32 $0.00 $14.40 $9.77 $9.77 $0.00 $0.00 $0.00 $3.75 $13.36 $13.36 $13.87 $0.00 $3.75 $0.00 $10.65 $10.65 $0.00 $9.00 $14.26 $14.40 $0.00 $0.00 $0.00 $2.82 $0.00 $0.00 $2.87 $0.00 $0.00 $0.00 $0.00 $0.00 27201931 EAP HCPCS C1729 Catheter Foley 16fr BOTH IP/OP $18.00 $13.32 $0.00 $14.40 $9.77 $9.77 $0.00 $0.00 $0.00 $3.75 $13.36 $13.36 $13.87 $0.00 $3.75 $0.00 $10.65 $10.65 $0.00 $9.00 $14.26 $14.40 $0.00 $11.70 $0.00 $2.82 $0.00 $0.00 $2.87 $0.00 $0.00 $0.00 $0.00 $0.00 27201932 EAP HCPCS C1729 Catheter Foley 5cc 18fr BOTH IP/OP $18.00 $13.32 $0.00 $14.40 $9.77 $9.77 $0.00 $0.00 $0.00 $3.75 $13.36 $13.36 $13.87 $0.00 $3.75 $0.00 $10.65 $10.65 $0.00 $9.00 $14.26 $14.40 $0.00 $0.00 $0.00 $2.82 $0.00 $0.00 $2.87 $0.00 $0.00 $0.00 $0.00 $0.00 27202362 EAP Custom 27202362 Scapel Surg W/handle Atta BOTH IP/OP $142.00 $105.08 $0.00 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $105.39 $105.39 $109.45 $0.00 $29.59 $0.00 $0.00 $0.00 $0.00 $71.00 $112.46 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202368 EAP Custom 27202368 Scapel Surg W/handle Att BOTH IP/OP $142.00 $105.08 $0.00 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $105.39 $105.39 $109.45 $0.00 $29.59 $0.00 $0.00 $0.00 $0.00 $71.00 $112.46 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202375 EAP HCPCS C1729 Catheter Foley 5cc 14fr BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $10.32 $10.32 $0.00 $0.00 $0.00 $3.96 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $11.24 $11.24 $0.00 $9.50 $15.05 $15.20 $0.00 $0.00 $0.00 $2.97 $0.00 $0.00 $3.02 $0.00 $0.00 $0.00 $0.00 $0.00 27202376 EAP HCPCS C1729 Catheter Foley 16fr BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $10.32 $10.32 $0.00 $0.00 $0.00 $3.96 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $11.24 $11.24 $0.00 $9.50 $15.05 $15.20 $0.00 $0.00 $0.00 $2.97 $0.00 $0.00 $3.02 $0.00 $0.00 $0.00 $0.00 $0.00 27202377 EAP HCPCS C1729 Catheter Foley 5cc 18fr BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $10.32 $10.32 $0.00 $0.00 $0.00 $3.96 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $11.24 $11.24 $0.00 $9.50 $15.05 $15.20 $0.00 $0.00 $0.00 $2.97 $0.00 $0.00 $3.02 $0.00 $0.00 $0.00 $0.00 $0.00 27202384 EAP HCPCS C1729 Catheter Foley 30cc 28fr BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $21.18 $21.18 $0.00 $0.00 $0.00 $8.13 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $23.07 $23.07 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $6.10 $0.00 $0.00 $6.21 $0.00 $0.00 $0.00 $0.00 $0.00 27202388 EAP HCPCS C1729 Catheter Foley 16fr BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $10.32 $10.32 $0.00 $0.00 $0.00 $3.96 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $11.24 $11.24 $0.00 $9.50 $15.05 $15.20 $0.00 $12.35 $0.00 $2.97 $0.00 $0.00 $3.02 $0.00 $0.00 $0.00 $0.00 $0.00 27202389 EAP HCPCS C1729 Catheter Coude Size 14fr BOTH IP/OP $109.00 $80.66 $0.00 $87.20 $59.19 $59.19 $0.00 $0.00 $0.00 $22.72 $80.90 $80.90 $84.02 $0.00 $22.72 $0.00 $64.47 $64.47 $0.00 $54.50 $86.33 $87.20 $0.00 $0.00 $0.00 $17.06 $0.00 $0.00 $17.35 $0.00 $0.00 $0.00 $0.00 $0.00 27202390 EAP HCPCS C1729 Catheter Coude Size 16fr BOTH IP/OP $109.00 $80.66 $0.00 $87.20 $59.19 $59.19 $0.00 $0.00 $0.00 $22.72 $80.90 $80.90 $84.02 $0.00 $22.72 $0.00 $64.47 $64.47 $0.00 $54.50 $86.33 $87.20 $0.00 $0.00 $0.00 $17.06 $0.00 $0.00 $17.35 $0.00 $0.00 $0.00 $0.00 $0.00 27202395 EAP HCPCS C1729 Catheter Coude Size 14fr BOTH IP/OP $109.00 $80.66 $0.00 $87.20 $59.19 $59.19 $0.00 $0.00 $0.00 $22.72 $80.90 $80.90 $84.02 $0.00 $22.72 $0.00 $64.47 $64.47 $0.00 $54.50 $86.33 $87.20 $0.00 $0.00 $0.00 $17.06 $0.00 $0.00 $17.35 $0.00 $0.00 $0.00 $0.00 $0.00 27202396 EAP HCPCS C1729 Catheter Coude 30cc 24fr BOTH IP/OP $82.00 $60.68 $0.00 $65.60 $44.53 $44.53 $0.00 $0.00 $0.00 $17.09 $60.86 $60.86 $63.21 $0.00 $17.09 $0.00 $48.50 $48.50 $0.00 $41.00 $64.94 $65.60 $0.00 $0.00 $0.00 $12.83 $0.00 $0.00 $13.05 $0.00 $0.00 $0.00 $0.00 $0.00 27202397 EAP Custom 27202397 Scapel Surg W/handle Atta BOTH IP/OP $142.00 $105.08 $0.00 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $105.39 $105.39 $109.45 $0.00 $29.59 $0.00 $0.00 $0.00 $0.00 $71.00 $112.46 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202403 EAP Custom 27202403 Scaple Surg W/handle Atta BOTH IP/OP $142.00 $105.08 $0.00 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $105.39 $105.39 $109.45 $0.00 $29.59 $0.00 $0.00 $0.00 $0.00 $71.00 $112.46 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202406 EAP HCPCS C1729 Catheter Coude Size 14fr BOTH IP/OP $47.00 $34.78 $0.00 $37.60 $25.52 $25.52 $0.00 $0.00 $0.00 $9.80 $34.88 $34.88 $36.23 $0.00 $9.79 $0.00 $27.80 $27.80 $0.00 $23.50 $37.22 $37.60 $0.00 $0.00 $0.00 $7.36 $0.00 $0.00 $7.48 $0.00 $0.00 $0.00 $0.00 $0.00 27202407 EAP HCPCS C1729 Catheter Coude 30cc 24fr BOTH IP/OP $87.00 $64.38 $0.00 $69.60 $47.24 $47.24 $0.00 $0.00 $0.00 $18.13 $64.57 $64.57 $67.06 $0.00 $18.13 $0.00 $51.46 $51.46 $0.00 $43.50 $68.90 $69.60 $0.00 $0.00 $0.00 $13.62 $0.00 $0.00 $13.85 $0.00 $0.00 $0.00 $0.00 $0.00 27202418 EAP HCPCS C1729 Catheter Foley 5cc 14fr BOTH IP/OP $18.00 $13.32 $0.00 $14.40 $9.77 $9.77 $0.00 $0.00 $0.00 $3.75 $13.36 $13.36 $13.87 $0.00 $3.75 $0.00 $10.65 $10.65 $0.00 $9.00 $14.26 $14.40 $0.00 $0.00 $0.00 $2.82 $0.00 $0.00 $2.87 $0.00 $0.00 $0.00 $0.00 $0.00 27202419 EAP HCPCS C1729 Catheter Foley 16fr BOTH IP/OP $18.00 $13.32 $0.00 $14.40 $9.77 $9.77 $0.00 $0.00 $0.00 $3.75 $13.36 $13.36 $13.87 $0.00 $3.75 $0.00 $10.65 $10.65 $0.00 $9.00 $14.26 $14.40 $0.00 $11.70 $0.00 $2.82 $0.00 $0.00 $2.87 $0.00 $0.00 $0.00 $0.00 $0.00 27202420 EAP HCPCS C1729 Catheter Foley 5cc 18fr BOTH IP/OP $18.00 $13.32 $0.00 $14.40 $9.77 $9.77 $0.00 $0.00 $0.00 $3.75 $13.36 $13.36 $13.87 $0.00 $3.75 $0.00 $10.65 $10.65 $0.00 $9.00 $14.26 $14.40 $0.00 $0.00 $0.00 $2.82 $0.00 $0.00 $2.87 $0.00 $0.00 $0.00 $0.00 $0.00 27202421 EAP HCPCS C1729 Catheter Foley 3-way 30cc BOTH IP/OP $37.00 $27.38 $0.00 $29.60 $20.09 $20.09 $0.00 $0.00 $0.00 $7.71 $27.46 $27.46 $28.52 $0.00 $7.71 $0.00 $21.89 $21.89 $0.00 $18.50 $29.30 $29.60 $0.00 $0.00 $0.00 $5.79 $0.00 $0.00 $5.89 $0.00 $0.00 $0.00 $0.00 $0.00 27202432 EAP HCPCS C1729 Catheter Foley 5cc 14fr BOTH IP/OP $18.00 $13.32 $0.00 $14.40 $9.77 $9.77 $0.00 $0.00 $0.00 $3.75 $13.36 $13.36 $13.87 $0.00 $3.75 $0.00 $10.65 $10.65 $0.00 $9.00 $14.26 $14.40 $0.00 $0.00 $0.00 $2.82 $0.00 $0.00 $2.87 $0.00 $0.00 $0.00 $0.00 $0.00 27202433 EAP HCPCS C1729 Catheter Coude Size 14fr BOTH IP/OP $109.00 $80.66 $0.00 $87.20 $59.19 $59.19 $0.00 $0.00 $0.00 $22.72 $80.90 $80.90 $84.02 $0.00 $22.72 $0.00 $64.47 $64.47 $0.00 $54.50 $86.33 $87.20 $0.00 $0.00 $0.00 $17.06 $0.00 $0.00 $17.35 $0.00 $0.00 $0.00 $0.00 $0.00 27202434 EAP HCPCS C1729 Catheter Coude Size 16fr BOTH IP/OP $102.00 $75.48 $0.00 $81.60 $55.39 $55.39 $0.00 $0.00 $0.00 $21.26 $75.70 $75.70 $78.62 $0.00 $21.26 $0.00 $60.33 $60.33 $0.00 $51.00 $80.78 $81.60 $0.00 $0.00 $0.00 $15.96 $0.00 $0.00 $16.24 $0.00 $0.00 $0.00 $0.00 $0.00 27202435 EAP Custom 27202435 Scapel Surg W/handle Attached BOTH IP/OP $142.00 $105.08 $0.00 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $105.39 $105.39 $109.45 $0.00 $29.59 $0.00 $0.00 $0.00 $0.00 $71.00 $112.46 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202446 EAP HCPCS C1729 Catheter Foley 5cc 14fr BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $10.32 $10.32 $0.00 $0.00 $0.00 $3.96 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $11.24 $11.24 $0.00 $9.50 $15.05 $15.20 $0.00 $0.00 $0.00 $2.97 $0.00 $0.00 $3.02 $0.00 $0.00 $0.00 $0.00 $0.00 27202447 EAP HCPCS C1729 Catheter Foley 16fr BOTH IP/OP $18.00 $13.32 $0.00 $14.40 $9.77 $9.77 $0.00 $0.00 $0.00 $3.75 $13.36 $13.36 $13.87 $0.00 $3.75 $0.00 $10.65 $10.65 $0.00 $9.00 $14.26 $14.40 $0.00 $11.70 $0.00 $2.82 $0.00 $0.00 $2.87 $0.00 $0.00 $0.00 $0.00 $0.00 27202448 EAP HCPCS C1729 Catheter Foley 5cc 18fr BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $10.32 $10.32 $0.00 $0.00 $0.00 $3.96 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $11.24 $11.24 $0.00 $9.50 $15.05 $15.20 $0.00 $0.00 $0.00 $2.97 $0.00 $0.00 $3.02 $0.00 $0.00 $0.00 $0.00 $0.00 27202449 EAP HCPCS C1729 Catheter Foley 30cc 28fr BOTH IP/OP $39.00 $28.86 $0.00 $31.20 $21.18 $21.18 $0.00 $0.00 $0.00 $8.13 $28.95 $28.95 $30.06 $0.00 $8.13 $0.00 $23.07 $23.07 $0.00 $19.50 $30.89 $31.20 $0.00 $0.00 $0.00 $6.10 $0.00 $0.00 $6.21 $0.00 $0.00 $0.00 $0.00 $0.00 27202462 EAP HCPCS C1729 Catheter Foley 5cc 14fr BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $10.32 $10.32 $0.00 $0.00 $0.00 $3.96 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $11.24 $11.24 $0.00 $9.50 $15.05 $15.20 $0.00 $0.00 $0.00 $2.97 $0.00 $0.00 $3.02 $0.00 $0.00 $0.00 $0.00 $0.00 27202463 EAP HCPCS C1729 Catheter Foley 5cc 18fr BOTH IP/OP $19.00 $14.06 $0.00 $15.20 $10.32 $10.32 $0.00 $0.00 $0.00 $3.96 $14.10 $14.10 $14.65 $0.00 $3.96 $0.00 $11.24 $11.24 $0.00 $9.50 $15.05 $15.20 $0.00 $0.00 $0.00 $2.97 $0.00 $0.00 $3.02 $0.00 $0.00 $0.00 $0.00 $0.00 27202470 EAP HCPCS C1751 Cragg-mcnamara 5-65-5 Infusion BOTH IP/OP $740.00 $547.60 $0.00 $592.00 $401.82 $401.82 $0.00 $0.00 $0.00 $154.23 $549.23 $549.23 $570.39 $0.00 $154.22 $0.00 $437.71 $437.71 $0.00 $370.00 $586.08 $592.00 $0.00 $0.00 $0.00 $115.81 $0.00 $0.00 $117.81 $0.00 $0.00 $0.00 $0.00 $0.00 27202471 EAP HCPCS C1751 Cragg-mcnamara 5-40-20 Infusio BOTH IP/OP $315.00 $233.10 $0.00 $252.00 $171.05 $171.05 $0.00 $0.00 $0.00 $65.65 $233.79 $233.79 $242.80 $0.00 $65.65 $0.00 $186.32 $186.32 $0.00 $157.50 $249.48 $252.00 $0.00 $204.75 $0.00 $49.30 $0.00 $0.00 $50.15 $0.00 $0.00 $0.00 $0.00 $0.00 27202472 EAP HCPCS C1751 Cragg-mcnamara 5-100-10 Infusi BOTH IP/OP $315.00 $233.10 $0.00 $252.00 $171.05 $171.05 $0.00 $0.00 $0.00 $65.65 $233.79 $233.79 $242.80 $0.00 $65.65 $0.00 $186.32 $186.32 $0.00 $157.50 $249.48 $252.00 $0.00 $0.00 $0.00 $49.30 $0.00 $0.00 $50.15 $0.00 $0.00 $0.00 $0.00 $0.00 27202473 EAP HCPCS C1773 15mm Amplatz Snare BOTH IP/OP $916.00 $677.84 $0.00 $732.80 $497.39 $497.39 $0.00 $0.00 $0.00 $190.92 $679.86 $679.86 $706.05 $0.00 $190.89 $0.00 $541.81 $541.81 $0.00 $458.00 $725.47 $732.80 $0.00 $595.40 $0.00 $143.35 $0.00 $0.00 $145.83 $0.00 $0.00 $0.00 $0.00 $0.00 27202474 EAP HCPCS C1773 25mm Amplatz Snare BOTH IP/OP $916.00 $677.84 $0.00 $732.80 $497.39 $497.39 $0.00 $0.00 $0.00 $190.92 $679.86 $679.86 $706.05 $0.00 $190.89 $0.00 $541.81 $541.81 $0.00 $458.00 $725.47 $732.80 $0.00 $595.40 $0.00 $143.35 $0.00 $0.00 $145.83 $0.00 $0.00 $0.00 $0.00 $0.00 27202475 EAP HCPCS C1729 10fr X 35cm Skater Nephrostomy BOTH IP/OP $254.00 $187.96 $0.00 $203.20 $137.92 $137.92 $0.00 $0.00 $0.00 $52.94 $188.52 $188.52 $195.78 $0.00 $52.93 $0.00 $150.24 $150.24 $0.00 $127.00 $201.17 $203.20 $0.00 $165.10 $0.00 $39.75 $0.00 $0.00 $40.44 $0.00 $0.00 $0.00 $0.00 $0.00 27202476 EAP HCPCS C1750 Chron Carbothane Cath 14.5f X 19cm BOTH IP/OP "$1,054.00 " $779.96 $0.00 $843.20 $572.32 $572.32 $0.00 $0.00 $0.00 $219.68 $782.28 $782.28 $812.42 $0.00 $219.65 $0.00 $623.44 $623.44 $0.00 $527.00 $834.77 $843.20 $0.00 $685.10 $0.00 $164.95 $0.00 $0.00 $167.80 $0.00 $0.00 $0.00 $0.00 $0.00 27202477 EAP HCPCS C1750 23cm Sport Pack Perm Dialysis BOTH IP/OP $921.00 $681.54 $0.00 $736.80 $500.10 $500.10 $0.00 $0.00 $0.00 $191.96 $683.57 $683.57 $709.91 $0.00 $191.94 $0.00 $544.77 $544.77 $0.00 $460.50 $729.43 $736.80 $0.00 $598.65 $0.00 $144.14 $0.00 $0.00 $146.62 $0.00 $0.00 $0.00 $0.00 $0.00 27202478 EAP HCPCS C1750 28cm Sport Pack Perm Dialysis BOTH IP/OP "$2,263.00 " "$1,674.62" $0.00 "$1,810.40" "$1,228.81" "$1,228.81" $0.00 $0.00 $0.00 $471.67 "$1,679.60" "$1,679.60" "$1,744.32" $0.00 $471.61 $0.00 "$1,338.56" "$1,338.56" $0.00 "$1,131.50" "$1,792.30" "$1,810.40" $0.00 $0.00 $0.00 $354.16 $0.00 $0.00 $360.27 $0.00 $0.00 $0.00 $0.00 $0.00 27202479 EAP HCPCS C1752 19cm Q-plus Temp Dialysis Kit BOTH IP/OP $254.00 $187.96 $0.00 $203.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $188.52 $188.52 $195.78 $0.00 $52.93 $0.00 $0.00 $0.00 $0.00 $127.00 $201.17 $203.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202480 EAP HCPCS C1894 Sheath Flex 6fr 11cm BOTH IP/OP $138.00 $102.12 $0.00 $110.40 $74.93 $74.93 $0.00 $0.00 $0.00 $28.76 $102.42 $102.42 $106.37 $0.00 $28.76 $0.00 $81.63 $81.63 $0.00 $69.00 $109.30 $110.40 $0.00 $0.00 $0.00 $21.60 $0.00 $0.00 $21.97 $0.00 $0.00 $0.00 $0.00 $0.00 27202481 EAP HCPCS C1751 Hickman 10.0 French Triple Lum BOTH IP/OP "$1,357.00 " "$1,004.18" $0.00 "$1,085.60" $736.85 $736.85 $0.00 $0.00 $0.00 $282.83 "$1,007.17" "$1,007.17" "$1,045.98" $0.00 $282.80 $0.00 $802.67 $802.67 $0.00 $678.50 "$1,074.74" "$1,085.60" $0.00 $0.00 $0.00 $212.37 $0.00 $0.00 $216.03 $0.00 $0.00 $0.00 $0.00 $0.00 27202482 EAP HCPCS C1725 Balloon Udt 4-2/5/120 BOTH IP/OP $717.00 $530.58 $0.00 $573.60 $389.33 $389.33 $0.00 $0.00 $0.00 $149.44 $532.16 $532.16 $552.66 $0.00 $149.42 $0.00 $424.11 $424.11 $0.00 $358.50 $567.86 $573.60 $0.00 $0.00 $0.00 $112.21 $0.00 $0.00 $114.15 $0.00 $0.00 $0.00 $0.00 $0.00 27202483 EAP HCPCS C1725 Conquest Dialation Balloon 5mm BOTH IP/OP $717.00 $530.58 $0.00 $573.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $358.50 $567.86 $573.60 $0.00 $0.00 $0.00 $112.21 $0.00 $0.00 $114.15 $0.00 $0.00 $0.00 $0.00 $0.00 27202484 EAP HCPCS C1725 Conquest Dialation Balloon 5mm BOTH IP/OP $717.00 $530.58 $0.00 $573.60 $389.33 $389.33 $0.00 $0.00 $0.00 $149.44 $532.16 $532.16 $552.66 $0.00 $149.42 $0.00 $424.11 $424.11 $0.00 $358.50 $567.86 $573.60 $0.00 $466.05 $0.00 $112.21 $0.00 $0.00 $114.15 $0.00 $0.00 $0.00 $0.00 $0.00 27202485 EAP HCPCS C1725 Conquest Dialation Balloon 6mm BOTH IP/OP $717.00 $530.58 $0.00 $573.60 $389.33 $389.33 $0.00 $0.00 $0.00 $149.44 $532.16 $532.16 $552.66 $0.00 $149.42 $0.00 $424.11 $424.11 $0.00 $358.50 $567.86 $573.60 $0.00 $466.05 $0.00 $112.21 $0.00 $0.00 $114.15 $0.00 $0.00 $0.00 $0.00 $0.00 27202486 EAP HCPCS C1725 Conquest Dialation Balloon 6mm BOTH IP/OP $717.00 $530.58 $0.00 $573.60 $0.00 $0.00 $0.00 $0.00 $0.00 $149.44 $0.00 $0.00 $0.00 $0.00 $149.42 $0.00 $424.11 $424.11 $0.00 $358.50 $567.86 $573.60 $0.00 $0.00 $0.00 $112.21 $0.00 $0.00 $114.15 $0.00 $0.00 $0.00 $0.00 $0.00 27202487 EAP HCPCS C1725 Conquest Dialation Balloon 7mm BOTH IP/OP $717.00 $530.58 $0.00 $573.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $358.50 $567.86 $573.60 $0.00 $0.00 $0.00 $112.21 $0.00 $0.00 $114.15 $0.00 $0.00 $0.00 $0.00 $0.00 27202488 EAP HCPCS C1725 Conquest Dialation Balloon 7mm BOTH IP/OP $717.00 $530.58 $0.00 $573.60 $389.33 $389.33 $0.00 $0.00 $0.00 $149.44 $532.16 $532.16 $552.66 $0.00 $149.42 $0.00 $424.11 $424.11 $0.00 $358.50 $567.86 $573.60 $0.00 $466.05 $0.00 $112.21 $0.00 $0.00 $114.15 $0.00 $0.00 $0.00 $0.00 $0.00 27202489 EAP HCPCS C1725 Conquest Dialation Balloon 8mm BOTH IP/OP $717.00 $530.58 $0.00 $573.60 $389.33 $389.33 $0.00 $0.00 $0.00 $149.44 $532.16 $532.16 $552.66 $0.00 $149.42 $0.00 $424.11 $424.11 $0.00 $358.50 $567.86 $573.60 $0.00 $466.05 $0.00 $112.21 $0.00 $0.00 $114.15 $0.00 $0.00 $0.00 $0.00 $0.00 27202490 EAP HCPCS C1725 Conquest Dialation Balloon 8mm BOTH IP/OP $717.00 $530.58 $0.00 $573.60 $389.33 $389.33 $0.00 $0.00 $0.00 $149.44 $532.16 $532.16 $552.66 $0.00 $149.42 $0.00 $424.11 $424.11 $0.00 $358.50 $567.86 $573.60 $0.00 $466.05 $0.00 $112.21 $0.00 $0.00 $114.15 $0.00 $0.00 $0.00 $0.00 $0.00 27202491 EAP HCPCS C1725 Conquest Dialation Balloon 10m BOTH IP/OP $717.00 $530.58 $0.00 $573.60 $389.33 $389.33 $0.00 $0.00 $0.00 $149.44 $532.16 $532.16 $552.66 $0.00 $149.42 $0.00 $424.11 $424.11 $0.00 $358.50 $567.86 $573.60 $0.00 $466.05 $0.00 $112.21 $0.00 $0.00 $114.15 $0.00 $0.00 $0.00 $0.00 $0.00 27202492 EAP HCPCS C1725 Conquest Dialation Balloon 10m BOTH IP/OP $717.00 $530.58 $0.00 $573.60 $389.33 $389.33 $0.00 $0.00 $0.00 $149.44 $532.16 $532.16 $552.66 $0.00 $149.42 $0.00 $424.11 $424.11 $0.00 $358.50 $567.86 $573.60 $0.00 $466.05 $0.00 $112.21 $0.00 $0.00 $114.15 $0.00 $0.00 $0.00 $0.00 $0.00 27202493 EAP HCPCS C1725 Conquest Dialation Balloon 12m BOTH IP/OP $717.00 $530.58 $0.00 $573.60 $389.33 $389.33 $0.00 $0.00 $0.00 $149.44 $532.16 $532.16 $552.66 $0.00 $149.42 $0.00 $424.11 $424.11 $0.00 $358.50 $567.86 $573.60 $0.00 $466.05 $0.00 $112.21 $0.00 $0.00 $114.15 $0.00 $0.00 $0.00 $0.00 $0.00 27202494 EAP HCPCS C1725 Balloon Dial Cath 4mmx10cmx120 BOTH IP/OP $717.00 $530.58 $0.00 $573.60 $389.33 $389.33 $0.00 $0.00 $0.00 $149.44 $532.16 $532.16 $552.66 $0.00 $149.42 $0.00 $424.11 $424.11 $0.00 $358.50 $567.86 $573.60 $0.00 $0.00 $0.00 $112.21 $0.00 $0.00 $114.15 $0.00 $0.00 $0.00 $0.00 $0.00 27202495 EAP HCPCS C1751 Vaxcel Central Venous Cath BOTH IP/OP $6.00 $4.44 $0.00 $4.80 $3.26 $3.26 $0.00 $0.00 $0.00 $1.25 $4.45 $4.45 $4.62 $0.00 $1.25 $0.00 $3.55 $3.55 $0.00 $3.00 $4.75 $4.80 $0.00 $0.00 $0.00 $0.94 $0.00 $0.00 $0.96 $0.00 $0.00 $0.00 $0.00 $0.00 27202496 EAP HCPCS C1725 4mmx2cmx90xm Monorail Balloon BOTH IP/OP "$1,407.00 " "$1,041.18" $0.00 "$1,125.60" $764.00 $764.00 $0.00 $0.00 $0.00 $293.25 "$1,044.28" "$1,044.28" "$1,084.52" $0.00 $293.22 $0.00 $832.24 $832.24 $0.00 $703.50 "$1,114.34" "$1,125.60" $0.00 $0.00 $0.00 $220.20 $0.00 $0.00 $223.99 $0.00 $0.00 $0.00 $0.00 $0.00 27202497 EAP HCPCS C1725 5mmx2cmx90cm Monorail Balloon BOTH IP/OP "$1,407.00 " "$1,041.18" $0.00 "$1,125.60" $764.00 $764.00 $0.00 $0.00 $0.00 $293.25 "$1,044.28" "$1,044.28" "$1,084.52" $0.00 $293.22 $0.00 $832.24 $832.24 $0.00 $703.50 "$1,114.34" "$1,125.60" $0.00 $0.00 $0.00 $220.20 $0.00 $0.00 $223.99 $0.00 $0.00 $0.00 $0.00 $0.00 27202498 EAP HCPCS C1725 5mmx15cmx90xcm Monorail Biliar BOTH IP/OP "$4,654.00 " "$3,443.96" $0.00 "$3,723.20" "$2,527.12" "$2,527.12" $0.00 $0.00 $0.00 $970.01 "$3,454.20" "$3,454.20" "$3,587.30" $0.00 $969.89 $0.00 "$2,752.84" "$2,752.84" $0.00 "$2,327.00" "$3,685.97" "$3,723.20" $0.00 $0.00 $0.00 $728.35 $0.00 $0.00 $740.92 $0.00 $0.00 $0.00 $0.00 $0.00 27202499 EAP HCPCS C1725 6mmx14cmx90cm Monorail Biliary BOTH IP/OP "$4,654.00 " "$3,443.96" $0.00 "$3,723.20" "$2,527.12" "$2,527.12" $0.00 $0.00 $0.00 $970.01 "$3,454.20" "$3,454.20" "$3,587.30" $0.00 $969.89 $0.00 "$2,752.84" "$2,752.84" $0.00 "$2,327.00" "$3,685.97" "$3,723.20" $0.00 $0.00 $0.00 $728.35 $0.00 $0.00 $740.92 $0.00 $0.00 $0.00 $0.00 $0.00 27202500 EAP HCPCS C1725 6mmx18cmx90cm Monorail Bilary BOTH IP/OP "$4,654.00 " "$3,443.96" $0.00 "$3,723.20" "$2,527.12" "$2,527.12" $0.00 $0.00 $0.00 $970.01 "$3,454.20" "$3,454.20" "$3,587.30" $0.00 $969.89 $0.00 "$2,752.84" "$2,752.84" $0.00 "$2,327.00" "$3,685.97" "$3,723.20" $0.00 $0.00 $0.00 $728.35 $0.00 $0.00 $740.92 $0.00 $0.00 $0.00 $0.00 $0.00 27202501 EAP HCPCS C1769 .018x190cm Thruway Guidewire BOTH IP/OP $291.00 $215.34 $0.00 $232.80 $158.01 $158.01 $0.00 $0.00 $0.00 $60.65 $215.98 $215.98 $224.30 $0.00 $60.64 $0.00 $172.13 $172.13 $0.00 $145.50 $230.47 $232.80 $0.00 $0.00 $0.00 $45.54 $0.00 $0.00 $46.33 $0.00 $0.00 $0.00 $0.00 $0.00 27202502 EAP HCPCS C1893 6frx45cm Renal Guiding Sheath BOTH IP/OP $260.00 $192.40 $0.00 $208.00 $141.18 $141.18 $0.00 $0.00 $0.00 $54.19 $192.97 $192.97 $200.41 $0.00 $54.18 $0.00 $153.79 $153.79 $0.00 $130.00 $205.92 $208.00 $0.00 $169.00 $0.00 $40.69 $0.00 $0.00 $41.39 $0.00 $0.00 $0.00 $0.00 $0.00 27202503 EAP HCPCS C1725 6x40x80 Polar Cath Balloon BOTH IP/OP "$4,496.00 " "$3,327.04" $0.00 "$3,596.80" "$2,441.33" "$2,441.33" $0.00 $0.00 $0.00 $937.08 "$3,336.93" "$3,336.93" "$3,465.52" $0.00 $936.97 $0.00 "$2,659.38" "$2,659.38" $0.00 "$2,248.00" "$3,560.83" "$3,596.80" $0.00 $0.00 $0.00 $703.62 $0.00 $0.00 $715.76 $0.00 $0.00 $0.00 $0.00 $0.00 27202504 EAP HCPCS C1725 7x60x80 Polar Cath Balloon BOTH IP/OP "$4,496.00 " "$3,327.04" $0.00 "$3,596.80" "$2,441.33" "$2,441.33" $0.00 $0.00 $0.00 $937.08 "$3,336.93" "$3,336.93" "$3,465.52" $0.00 $936.97 $0.00 "$2,659.38" "$2,659.38" $0.00 "$2,248.00" "$3,560.83" "$3,596.80" $0.00 $0.00 $0.00 $703.62 $0.00 $0.00 $715.76 $0.00 $0.00 $0.00 $0.00 $0.00 27202505 EAP HCPCS C2629 Banana Peel Sheath BOTH IP/OP $151.00 $111.74 $0.00 $120.80 $0.00 $0.00 $0.00 $0.00 $0.00 $31.47 $112.07 $112.07 $116.39 $0.00 $31.47 $0.00 $89.32 $89.32 $0.00 $75.50 $119.59 $120.80 $0.00 $0.00 $0.00 $23.63 $0.00 $0.00 $24.04 $0.00 $0.00 $0.00 $0.00 $0.00 27202506 EAP HCPCS C1769 Guidewite .014x180 Segway Gt BOTH IP/OP $417.00 $308.58 $0.00 $333.60 $226.43 $226.43 $0.00 $0.00 $0.00 $86.91 $309.50 $309.50 $321.42 $0.00 $86.90 $0.00 $246.66 $246.66 $0.00 $208.50 $330.26 $333.60 $0.00 $0.00 $0.00 $65.26 $0.00 $0.00 $66.39 $0.00 $0.00 $0.00 $0.00 $0.00 27202507 EAP HCPCS C1769 Guidewire .018x180cm Segway Gt BOTH IP/OP $417.00 $308.58 $0.00 $333.60 $226.43 $226.43 $0.00 $0.00 $0.00 $86.91 $309.50 $309.50 $321.42 $0.00 $86.90 $0.00 $246.66 $246.66 $0.00 $208.50 $330.26 $333.60 $0.00 $271.05 $0.00 $65.26 $0.00 $0.00 $66.39 $0.00 $0.00 $0.00 $0.00 $0.00 27202508 EAP HCPCS C1769 Str Guidewire .014x180 Segway BOTH IP/OP $417.00 $308.58 $0.00 $333.60 $226.43 $226.43 $0.00 $0.00 $0.00 $86.91 $309.50 $309.50 $321.42 $0.00 $86.90 $0.00 $246.66 $246.66 $0.00 $208.50 $330.26 $333.60 $0.00 $0.00 $0.00 $65.26 $0.00 $0.00 $66.39 $0.00 $0.00 $0.00 $0.00 $0.00 27202509 EAP HCPCS C1751 Infusion Embo Cath Segway BOTH IP/OP $835.00 $617.90 $0.00 $668.00 $453.41 $453.41 $0.00 $0.00 $0.00 $174.03 $619.74 $619.74 $643.62 $0.00 $174.01 $0.00 $493.90 $493.90 $0.00 $417.50 $661.32 $668.00 $0.00 $0.00 $0.00 $130.68 $0.00 $0.00 $132.93 $0.00 $0.00 $0.00 $0.00 $0.00 27202510 EAP HCPCS C1757 Complex Helical Coil BOTH IP/OP $239.00 $176.86 $0.00 $191.20 $129.78 $129.78 $0.00 $0.00 $0.00 $49.81 $177.39 $177.39 $184.22 $0.00 $49.81 $0.00 $141.37 $141.37 $0.00 $119.50 $189.29 $191.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202511 EAP HCPCS C1894 6fr Dial Ease Introducer Sheat BOTH IP/OP $43.00 $31.82 $0.00 $34.40 $23.35 $23.35 $0.00 $0.00 $0.00 $8.96 $31.91 $31.91 $33.14 $0.00 $8.96 $0.00 $25.43 $25.43 $0.00 $21.50 $34.06 $34.40 $0.00 $27.95 $0.00 $6.73 $0.00 $0.00 $6.85 $0.00 $0.00 $0.00 $0.00 $0.00 27202512 EAP HCPCS C1725 7-2/7/75 Workhorse Balloon BOTH IP/OP $438.00 $324.12 $0.00 $350.40 $237.83 $237.83 $0.00 $0.00 $0.00 $91.29 $325.08 $325.08 $337.61 $0.00 $91.28 $0.00 $259.08 $259.08 $0.00 $219.00 $346.90 $350.40 $0.00 $0.00 $0.00 $68.55 $0.00 $0.00 $69.73 $0.00 $0.00 $0.00 $0.00 $0.00 27202513 EAP HCPCS C1725 7-4/5/75 Workhorse Balloon BOTH IP/OP $427.00 $315.98 $0.00 $341.60 $231.86 $231.86 $0.00 $0.00 $0.00 $89.00 $316.92 $316.92 $329.13 $0.00 $88.99 $0.00 $252.57 $252.57 $0.00 $213.50 $338.18 $341.60 $0.00 $0.00 $0.00 $66.83 $0.00 $0.00 $67.98 $0.00 $0.00 $0.00 $0.00 $0.00 27202514 EAP HCPCS C1894 10fr 25cm Pinnacle Sheath Intr BOTH IP/OP $67.00 $49.58 $0.00 $53.60 $36.38 $36.38 $0.00 $0.00 $0.00 $13.96 $49.73 $49.73 $51.64 $0.00 $13.96 $0.00 $39.63 $39.63 $0.00 $33.50 $53.06 $53.60 $0.00 $43.55 $0.00 $10.49 $0.00 $0.00 $10.67 $0.00 $0.00 $0.00 $0.00 $0.00 27202515 EAP HCPCS C1894 5fr 25cm Pinnacle Introducer S BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $32.04 $32.04 $0.00 $0.00 $0.00 $12.30 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $34.90 $34.90 $0.00 $29.50 $46.73 $47.20 $0.00 $38.35 $0.00 $9.23 $0.00 $0.00 $9.39 $0.00 $0.00 $0.00 $0.00 $0.00 27202516 EAP HCPCS C1894 9fr 25cm Pinnacle Introducer S BOTH IP/OP $67.00 $49.58 $0.00 $53.60 $36.38 $36.38 $0.00 $0.00 $0.00 $13.96 $49.73 $49.73 $51.64 $0.00 $13.96 $0.00 $39.63 $39.63 $0.00 $33.50 $53.06 $53.60 $0.00 $0.00 $0.00 $10.49 $0.00 $0.00 $10.67 $0.00 $0.00 $0.00 $0.00 $0.00 27202517 EAP HCPCS C1894 6fr 25cm Pinnacle Introducer S BOTH IP/OP $67.00 $49.58 $0.00 $53.60 $36.38 $36.38 $0.00 $0.00 $0.00 $13.96 $49.73 $49.73 $51.64 $0.00 $13.96 $0.00 $39.63 $39.63 $0.00 $33.50 $53.06 $53.60 $0.00 $0.00 $0.00 $10.49 $0.00 $0.00 $10.67 $0.00 $0.00 $0.00 $0.00 $0.00 27202518 EAP HCPCS C1894 7fr 25cm Pinnacle Introducer S BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $32.04 $32.04 $0.00 $0.00 $0.00 $12.30 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $34.90 $34.90 $0.00 $29.50 $46.73 $47.20 $0.00 $38.35 $0.00 $9.23 $0.00 $0.00 $9.39 $0.00 $0.00 $0.00 $0.00 $0.00 27202519 EAP HCPCS C1750 23cm Hemoglide Perm Cath BOTH IP/OP "$2,140.00 " "$1,583.60" $0.00 "$1,712.00" "$1,162.02" "$1,162.02" $0.00 $0.00 $0.00 $446.03 "$1,588.31" "$1,588.31" "$1,649.51" $0.00 $445.98 $0.00 "$1,265.81" "$1,265.81" $0.00 "$1,070.00" "$1,694.88" "$1,712.00" $0.00 $0.00 $0.00 $334.91 $0.00 $0.00 $340.69 $0.00 $0.00 $0.00 $0.00 $0.00 27202520 EAP HCPCS C1750 19cm Hemoglide Perm Cath BOTH IP/OP $916.00 $677.84 $0.00 $732.80 $497.39 $497.39 $0.00 $0.00 $0.00 $190.92 $679.86 $679.86 $706.05 $0.00 $190.89 $0.00 $541.81 $541.81 $0.00 $458.00 $725.47 $732.80 $0.00 $0.00 $0.00 $143.35 $0.00 $0.00 $145.83 $0.00 $0.00 $0.00 $0.00 $0.00 27202521 EAP HCPCS C1769 Nitrex Guidewire BOTH IP/OP $728.00 $538.72 $0.00 $582.40 $395.30 $395.30 $0.00 $0.00 $0.00 $151.73 $540.32 $540.32 $561.14 $0.00 $151.72 $0.00 $430.61 $430.61 $0.00 $364.00 $576.58 $582.40 $0.00 $0.00 $0.00 $113.93 $0.00 $0.00 $115.90 $0.00 $0.00 $0.00 $0.00 $0.00 27202522 EAP HCPCS C1769 Disposable Tip Deflecting Wire BOTH IP/OP $567.00 $419.58 $0.00 $453.60 $307.88 $307.88 $0.00 $0.00 $0.00 $118.18 $420.83 $420.83 $437.04 $0.00 $118.16 $0.00 $335.38 $335.38 $0.00 $283.50 $449.06 $453.60 $0.00 $368.55 $0.00 $88.74 $0.00 $0.00 $90.27 $0.00 $0.00 $0.00 $0.00 $0.00 27202523 EAP HCPCS C1894 10fr Pinnacle Introducer BOTH IP/OP $76.00 $56.24 $0.00 $60.80 $41.27 $41.27 $0.00 $0.00 $0.00 $15.84 $56.41 $56.41 $58.58 $0.00 $15.84 $0.00 $44.95 $44.95 $0.00 $38.00 $60.19 $60.80 $0.00 $49.40 $0.00 $11.89 $0.00 $0.00 $12.10 $0.00 $0.00 $0.00 $0.00 $0.00 27202524 EAP HCPCS C1752 Niagra Dialysis Catheter BOTH IP/OP $203.00 $150.22 $0.00 $162.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $150.67 $150.67 $156.47 $0.00 $42.31 $0.00 $0.00 $0.00 $0.00 $101.50 $160.78 $162.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202525 EAP HCPCS C2629 5fr Tear-away Introducer BOTH IP/OP $81.00 $59.94 $0.00 $64.80 $0.00 $0.00 $0.00 $0.00 $0.00 $16.88 $60.12 $60.12 $62.43 $0.00 $16.88 $0.00 $47.91 $47.91 $0.00 $40.50 $64.15 $64.80 $0.00 $52.65 $0.00 $12.68 $0.00 $0.00 $12.90 $0.00 $0.00 $0.00 $0.00 $0.00 27202526 EAP HCPCS C2629 6fr Tear-away Introducer BOTH IP/OP $856.00 $633.44 $0.00 $684.80 $0.00 $0.00 $0.00 $0.00 $0.00 $178.41 $635.32 $635.32 $659.80 $0.00 $178.39 $0.00 $506.32 $506.32 $0.00 $428.00 $677.95 $684.80 $0.00 $556.40 $0.00 $133.96 $0.00 $0.00 $136.28 $0.00 $0.00 $0.00 $0.00 $0.00 27202527 EAP HCPCS C2629 8 Fr Tear Away Introducer BOTH IP/OP $397.00 $293.78 $0.00 $317.60 $0.00 $0.00 $0.00 $0.00 $0.00 $82.74 $294.65 $294.65 $306.01 $0.00 $82.73 $0.00 $234.83 $234.83 $0.00 $198.50 $314.42 $317.60 $0.00 $0.00 $0.00 $62.13 $0.00 $0.00 $63.20 $0.00 $0.00 $0.00 $0.00 $0.00 27202528 EAP HCPCS C2629 9fr Tear-away Introducer BOTH IP/OP $81.00 $59.94 $0.00 $64.80 $0.00 $0.00 $0.00 $0.00 $0.00 $16.88 $60.12 $60.12 $62.43 $0.00 $16.88 $0.00 $47.91 $47.91 $0.00 $40.50 $64.15 $64.80 $0.00 $52.65 $0.00 $12.68 $0.00 $0.00 $12.90 $0.00 $0.00 $0.00 $0.00 $0.00 27202529 EAP HCPCS C2629 10fr-16cm Introducer BOTH IP/OP $85.00 $62.90 $0.00 $68.00 $0.00 $0.00 $0.00 $0.00 $0.00 $17.72 $63.09 $63.09 $65.52 $0.00 $17.71 $0.00 $50.28 $50.28 $0.00 $42.50 $67.32 $68.00 $0.00 $0.00 $0.00 $13.30 $0.00 $0.00 $13.53 $0.00 $0.00 $0.00 $0.00 $0.00 27202530 EAP Custom 27202530 18 Ga Needle Sterile Guide BOTH IP/OP $65.00 $48.10 $0.00 $52.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $48.24 $48.24 $50.10 $0.00 $13.55 $0.00 $0.00 $0.00 $0.00 $32.50 $51.48 $52.00 $0.00 $42.25 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202531 EAP HCPCS C1729 12fr Flexima Biliary Cath BOTH IP/OP $291.00 $215.34 $0.00 $232.80 $158.01 $158.01 $0.00 $0.00 $0.00 $60.65 $215.98 $215.98 $224.30 $0.00 $60.64 $0.00 $172.13 $172.13 $0.00 $145.50 $230.47 $232.80 $0.00 $0.00 $0.00 $45.54 $0.00 $0.00 $46.33 $0.00 $0.00 $0.00 $0.00 $0.00 27202532 EAP HCPCS C1757 2mmx20mm Complex Helical BOTH IP/OP $257.00 $190.18 $0.00 $205.60 $139.55 $139.55 $0.00 $0.00 $0.00 $53.57 $190.75 $190.75 $198.10 $0.00 $53.56 $0.00 $152.02 $152.02 $0.00 $128.50 $203.54 $205.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202533 EAP HCPCS C1725 4-4/5/75 Balloon Catheter BOTH IP/OP $681.00 $503.94 $0.00 $544.80 $369.78 $369.78 $0.00 $0.00 $0.00 $141.94 $505.44 $505.44 $524.91 $0.00 $141.92 $0.00 $402.81 $402.81 $0.00 $340.50 $539.35 $544.80 $0.00 $0.00 $0.00 $106.58 $0.00 $0.00 $108.42 $0.00 $0.00 $0.00 $0.00 $0.00 27202534 EAP HCPCS C1769 46fr-65cm C2 Glidecath BOTH IP/OP $167.00 $123.58 $0.00 $133.60 $90.68 $90.68 $0.00 $0.00 $0.00 $34.81 $123.95 $123.95 $128.72 $0.00 $34.80 $0.00 $98.78 $98.78 $0.00 $83.50 $132.26 $133.60 $0.00 $0.00 $0.00 $26.14 $0.00 $0.00 $26.59 $0.00 $0.00 $0.00 $0.00 $0.00 27202535 EAP HCPCS C1757 4mmx30mm Complex Helical BOTH IP/OP $265.00 $196.10 $0.00 $212.00 $143.90 $143.90 $0.00 $0.00 $0.00 $55.23 $196.68 $196.68 $204.26 $0.00 $55.23 $0.00 $156.75 $156.75 $0.00 $132.50 $209.88 $212.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202536 EAP HCPCS C1725 Bmx 8-3/5.8/75 Balloon Ca BOTH IP/OP $916.00 $677.84 $0.00 $732.80 $497.39 $497.39 $0.00 $0.00 $0.00 $190.92 $679.86 $679.86 $706.05 $0.00 $190.89 $0.00 $541.81 $541.81 $0.00 $458.00 $725.47 $732.80 $0.00 $0.00 $0.00 $143.35 $0.00 $0.00 $145.83 $0.00 $0.00 $0.00 $0.00 $0.00 27202537 EAP HCPCS C1725 Bmx14-4/7/100 Ballon Gath BOTH IP/OP "$1,008.00 " $745.92 $0.00 $806.40 $547.34 $547.34 $0.00 $0.00 $0.00 $210.09 $748.14 $748.14 $776.97 $0.00 $210.07 $0.00 $596.23 $596.23 $0.00 $504.00 $798.34 $806.40 $0.00 $0.00 $0.00 $157.75 $0.00 $0.00 $160.47 $0.00 $0.00 $0.00 $0.00 $0.00 27202538 EAP HCPCS C1729 Catheter 10fr Flexima BOTH IP/OP $291.00 $215.34 $0.00 $232.80 $158.01 $158.01 $0.00 $0.00 $0.00 $60.65 $215.98 $215.98 $224.30 $0.00 $60.64 $0.00 $172.13 $172.13 $0.00 $145.50 $230.47 $232.80 $0.00 $189.15 $0.00 $45.54 $0.00 $0.00 $46.33 $0.00 $0.00 $0.00 $0.00 $0.00 27202539 EAP HCPCS C1729 Catheter 14fr Flexima BOTH IP/OP $282.00 $208.68 $0.00 $225.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $141.00 $223.34 $225.60 $0.00 $0.00 $0.00 $44.13 $0.00 $0.00 $44.89 $0.00 $0.00 $0.00 $0.00 $0.00 27202540 EAP HCPCS C1751 Catheter 9cm Katzen BOTH IP/OP "$1,506.00 " "$1,114.44" $0.00 "$1,204.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $753.00 "$1,192.75" "$1,204.80" $0.00 $0.00 $0.00 $235.69 $0.00 $0.00 $239.76 $0.00 $0.00 $0.00 $0.00 $0.00 27202541 EAP HCPCS C1725 Catheter Balloon Dc/20 BOTH IP/OP "$2,062.00 " "$1,525.88" $0.00 "$1,649.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,031.00" "$1,633.10" "$1,649.60" $0.00 $0.00 $0.00 $322.70 $0.00 $0.00 $328.27 $0.00 $0.00 $0.00 $0.00 $0.00 27202542 EAP HCPCS C1725 Catheter Balloon Ultra- BOTH IP/OP $718.00 $531.32 $0.00 $574.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $359.00 $568.66 $574.40 $0.00 $0.00 $0.00 $112.37 $0.00 $0.00 $114.31 $0.00 $0.00 $0.00 $0.00 $0.00 27202543 EAP HCPCS C1887 Glidecath: 100cm Straight BOTH IP/OP $838.00 $620.12 $0.00 $670.40 $455.03 $455.03 $0.00 $0.00 $0.00 $174.66 $621.96 $621.96 $645.93 $0.00 $174.64 $0.00 $495.68 $495.68 $0.00 $419.00 $663.70 $670.40 $0.00 $544.70 $0.00 $131.15 $0.00 $0.00 $133.41 $0.00 $0.00 $0.00 $0.00 $0.00 27202544 EAP HCPCS C1887 Guidecath 5fr-100cm BOTH IP/OP $175.00 $129.50 $0.00 $140.00 $95.03 $95.03 $0.00 $0.00 $0.00 $36.47 $129.89 $129.89 $134.89 $0.00 $36.47 $0.00 $103.51 $103.51 $0.00 $87.50 $138.60 $140.00 $0.00 $113.75 $0.00 $27.39 $0.00 $0.00 $27.86 $0.00 $0.00 $0.00 $0.00 $0.00 27202545 EAP HCPCS C1769 Guidewire .035/150cm BOTH IP/OP "$1,424.00 " "$1,053.76" $0.00 "$1,139.20" $773.23 $773.23 $0.00 $0.00 $0.00 $296.80 "$1,056.89" "$1,056.89" "$1,097.62" $0.00 $296.76 $0.00 $842.30 $842.30 $0.00 $712.00 "$1,127.81" "$1,139.20" $0.00 $925.60 $0.00 $222.86 $0.00 $0.00 $226.70 $0.00 $0.00 $0.00 $0.00 $0.00 27202546 EAP HCPCS C1769 Transcend -ex Guidewire BOTH IP/OP "$1,759.00 " "$1,301.66" $0.00 "$1,407.20" $955.14 $955.14 $0.00 $0.00 $0.00 $366.62 "$1,305.53" "$1,305.53" "$1,355.84" $0.00 $366.58 $0.00 "$1,040.45" "$1,040.45" $0.00 $879.50 "$1,393.13" "$1,407.20" $0.00 $0.00 $0.00 $275.28 $0.00 $0.00 $280.03 $0.00 $0.00 $0.00 $0.00 $0.00 27202547 EAP HCPCS C1725 Udt6-10/5/120 Ballon Cath BOTH IP/OP $717.00 $530.58 $0.00 $573.60 $389.33 $389.33 $0.00 $0.00 $0.00 $149.44 $532.16 $532.16 $552.66 $0.00 $149.42 $0.00 $424.11 $424.11 $0.00 $358.50 $567.86 $573.60 $0.00 $0.00 $0.00 $112.21 $0.00 $0.00 $114.15 $0.00 $0.00 $0.00 $0.00 $0.00 27202548 EAP HCPCS C1769 V-18 Control Guidewires BOTH IP/OP $313.00 $231.62 $0.00 $250.40 $169.96 $169.96 $0.00 $0.00 $0.00 $65.24 $232.31 $232.31 $241.26 $0.00 $65.23 $0.00 $185.14 $185.14 $0.00 $156.50 $247.90 $250.40 $0.00 $0.00 $0.00 $48.98 $0.00 $0.00 $49.83 $0.00 $0.00 $0.00 $0.00 $0.00 27202549 EAP HCPCS C1725 Xxl 18-4/5.8/120e Ball Ga BOTH IP/OP $934.00 $691.16 $0.00 $747.20 $507.16 $507.16 $0.00 $0.00 $0.00 $194.67 $693.21 $693.21 $719.93 $0.00 $194.65 $0.00 $552.46 $552.46 $0.00 $467.00 $739.73 $747.20 $0.00 $0.00 $0.00 $146.17 $0.00 $0.00 $148.69 $0.00 $0.00 $0.00 $0.00 $0.00 27202550 EAP HCPCS C1769 Guidewire .035-260cm Rosen BOTH IP/OP $68.00 $50.32 $0.00 $54.40 $36.92 $36.92 $0.00 $0.00 $0.00 $14.17 $50.47 $50.47 $52.41 $0.00 $14.17 $0.00 $40.22 $40.22 $0.00 $34.00 $53.86 $54.40 $0.00 $44.20 $0.00 $10.64 $0.00 $0.00 $10.83 $0.00 $0.00 $0.00 $0.00 $0.00 27202551 EAP HCPCS C1729 10.2fr Biliary Drain Cath BOTH IP/OP $289.00 $213.86 $0.00 $231.20 $156.93 $156.93 $0.00 $0.00 $0.00 $60.23 $214.50 $214.50 $222.76 $0.00 $60.23 $0.00 $170.94 $170.94 $0.00 $144.50 $228.89 $231.20 $0.00 $187.85 $0.00 $45.23 $0.00 $0.00 $46.01 $0.00 $0.00 $0.00 $0.00 $0.00 27202552 EAP HCPCS C1729 12.0fr Biliary Drain Cath BOTH IP/OP $296.00 $219.04 $0.00 $236.80 $160.73 $160.73 $0.00 $0.00 $0.00 $61.69 $219.69 $219.69 $228.16 $0.00 $61.69 $0.00 $175.08 $175.08 $0.00 $148.00 $234.43 $236.80 $0.00 $192.40 $0.00 $46.32 $0.00 $0.00 $47.12 $0.00 $0.00 $0.00 $0.00 $0.00 27202553 EAP HCPCS C1729 12.0fr Mp Drain Catheter BOTH IP/OP $296.00 $219.04 $0.00 $236.80 $160.73 $160.73 $0.00 $0.00 $0.00 $61.69 $219.69 $219.69 $228.16 $0.00 $61.69 $0.00 $175.08 $175.08 $0.00 $148.00 $234.43 $236.80 $0.00 $192.40 $0.00 $46.32 $0.00 $0.00 $47.12 $0.00 $0.00 $0.00 $0.00 $0.00 27202554 EAP HCPCS C1729 14.0fr Biliary Drain BOTH IP/OP $296.00 $219.04 $0.00 $236.80 $160.73 $160.73 $0.00 $0.00 $0.00 $61.69 $219.69 $219.69 $228.16 $0.00 $61.69 $0.00 $175.08 $175.08 $0.00 $148.00 $234.43 $236.80 $0.00 $192.40 $0.00 $46.32 $0.00 $0.00 $47.12 $0.00 $0.00 $0.00 $0.00 $0.00 27202555 EAP HCPCS C1769 35-180 Coons Wire BOTH IP/OP $192.00 $142.08 $0.00 $153.60 $104.26 $104.26 $0.00 $0.00 $0.00 $40.02 $142.50 $142.50 $147.99 $0.00 $40.01 $0.00 $113.57 $113.57 $0.00 $96.00 $152.06 $153.60 $0.00 $0.00 $0.00 $30.05 $0.00 $0.00 $30.57 $0.00 $0.00 $0.00 $0.00 $0.00 27202556 EAP HCPCS C1757 35-2-3 Embolization Coil BOTH IP/OP $172.00 $127.28 $0.00 $137.60 $93.40 $93.40 $0.00 $0.00 $0.00 $35.85 $127.66 $127.66 $132.58 $0.00 $35.84 $0.00 $101.74 $101.74 $0.00 $86.00 $136.22 $137.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202557 EAP HCPCS C1725 7fr-100cm Montef 10re Cat BOTH IP/OP $54.00 $39.96 $0.00 $43.20 $29.32 $29.32 $0.00 $0.00 $0.00 $11.25 $40.08 $40.08 $41.62 $0.00 $11.25 $0.00 $31.94 $31.94 $0.00 $27.00 $42.77 $43.20 $0.00 $35.10 $0.00 $8.45 $0.00 $0.00 $8.60 $0.00 $0.00 $0.00 $0.00 $0.00 27202558 EAP HCPCS C1894 8fr Balkanintroducer BOTH IP/OP $170.00 $125.80 $0.00 $136.00 $92.31 $92.31 $0.00 $0.00 $0.00 $35.43 $126.17 $126.17 $131.04 $0.00 $35.43 $0.00 $100.56 $100.56 $0.00 $85.00 $134.64 $136.00 $0.00 $0.00 $0.00 $26.61 $0.00 $0.00 $27.06 $0.00 $0.00 $0.00 $0.00 $0.00 27202559 EAP HCPCS C1894 9fr Flexor Introducer BOTH IP/OP $159.00 $117.66 $0.00 $127.20 $86.34 $86.34 $0.00 $0.00 $0.00 $33.14 $118.01 $118.01 $122.56 $0.00 $33.14 $0.00 $94.05 $94.05 $0.00 $79.50 $125.93 $127.20 $0.00 $0.00 $0.00 $24.88 $0.00 $0.00 $25.31 $0.00 $0.00 $0.00 $0.00 $0.00 27202560 EAP HCPCS C1757 Coil Embolization 35-5-5 BOTH IP/OP $172.00 $127.28 $0.00 $137.60 $93.40 $93.40 $0.00 $0.00 $0.00 $35.85 $127.66 $127.66 $132.58 $0.00 $35.84 $0.00 $101.74 $101.74 $0.00 $86.00 $136.22 $137.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202561 EAP HCPCS C1751 135 Cm Mass Transit Max BOTH IP/OP "$2,960.00 " "$2,190.40" $0.00 "$2,368.00" "$1,607.28" "$1,607.28" $0.00 $0.00 $0.00 $616.94 "$2,196.91" "$2,196.91" "$2,281.57" $0.00 $616.86 $0.00 "$1,750.84" "$1,750.84" $0.00 "$1,480.00" "$2,344.32" "$2,368.00" $0.00 $0.00 $0.00 $463.24 $0.00 $0.00 $471.23 $0.00 $0.00 $0.00 $0.00 $0.00 27202562 EAP HCPCS C1894 Introducer Pinnacle 7fr 10cm BOTH IP/OP $67.00 $49.58 $0.00 $53.60 $36.38 $36.38 $0.00 $0.00 $0.00 $13.96 $49.73 $49.73 $51.64 $0.00 $13.96 $0.00 $39.63 $39.63 $0.00 $33.50 $53.06 $53.60 $0.00 $0.00 $0.00 $10.49 $0.00 $0.00 $10.67 $0.00 $0.00 $0.00 $0.00 $0.00 27202563 EAP HCPCS C1725 Balloon Udt 4-4/5/120 BOTH IP/OP $717.00 $530.58 $0.00 $573.60 $389.33 $389.33 $0.00 $0.00 $0.00 $149.44 $532.16 $532.16 $552.66 $0.00 $149.42 $0.00 $424.11 $424.11 $0.00 $358.50 $567.86 $573.60 $0.00 $0.00 $0.00 $112.21 $0.00 $0.00 $114.15 $0.00 $0.00 $0.00 $0.00 $0.00 27202564 EAP HCPCS C1887 5fr.100cmhinck Headhunter BOTH IP/OP $167.00 $123.58 $0.00 $133.60 $90.68 $90.68 $0.00 $0.00 $0.00 $34.81 $123.95 $123.95 $128.72 $0.00 $34.80 $0.00 $98.78 $98.78 $0.00 $83.50 $132.26 $133.60 $0.00 $108.55 $0.00 $26.14 $0.00 $0.00 $26.59 $0.00 $0.00 $0.00 $0.00 $0.00 27202565 EAP HCPCS C1894 8fr 25cm Pinnacle Introducer S BOTH IP/OP $59.00 $43.66 $0.00 $47.20 $32.04 $32.04 $0.00 $0.00 $0.00 $12.30 $43.79 $43.79 $45.48 $0.00 $12.30 $0.00 $34.90 $34.90 $0.00 $29.50 $46.73 $47.20 $0.00 $38.35 $0.00 $9.23 $0.00 $0.00 $9.39 $0.00 $0.00 $0.00 $0.00 $0.00 27202566 EAP HCPCS C1887 5f-90cm Ruc Catheter BOTH IP/OP $129.00 $95.46 $0.00 $103.20 $70.05 $70.05 $0.00 $0.00 $0.00 $26.89 $95.74 $95.74 $99.43 $0.00 $26.88 $0.00 $76.30 $76.30 $0.00 $64.50 $102.17 $103.20 $0.00 $0.00 $0.00 $20.19 $0.00 $0.00 $20.54 $0.00 $0.00 $0.00 $0.00 $0.00 27202567 EAP HCPCS C2629 Introducer Tear Away 120fx30cm BOTH IP/OP $142.00 $105.08 $0.00 $113.60 $0.00 $0.00 $0.00 $0.00 $0.00 $29.60 $105.39 $105.39 $109.45 $0.00 $29.59 $0.00 $83.99 $83.99 $0.00 $71.00 $112.46 $113.60 $0.00 $0.00 $0.00 $22.22 $0.00 $0.00 $22.61 $0.00 $0.00 $0.00 $0.00 $0.00 27202568 EAP HCPCS C2629 Introducer Tear Away 16f X15cm BOTH IP/OP $68.00 $50.32 $0.00 $54.40 $0.00 $0.00 $0.00 $0.00 $0.00 $14.17 $50.47 $50.47 $52.41 $0.00 $14.17 $0.00 $40.22 $40.22 $0.00 $34.00 $53.86 $54.40 $0.00 $0.00 $0.00 $10.64 $0.00 $0.00 $10.83 $0.00 $0.00 $0.00 $0.00 $0.00 27202569 EAP HCPCS C2629 Introducer Tear Away 14f X15cm BOTH IP/OP $68.00 $50.32 $0.00 $54.40 $0.00 $0.00 $0.00 $0.00 $0.00 $14.17 $50.47 $50.47 $52.41 $0.00 $14.17 $0.00 $40.22 $40.22 $0.00 $34.00 $53.86 $54.40 $0.00 $0.00 $0.00 $10.64 $0.00 $0.00 $10.83 $0.00 $0.00 $0.00 $0.00 $0.00 27202570 EAP HCPCS C2629 Introducer Tear Away12.5fx15cm BOTH IP/OP $103.00 $76.22 $0.00 $82.40 $0.00 $0.00 $0.00 $0.00 $0.00 $21.47 $76.45 $76.45 $79.39 $0.00 $21.47 $0.00 $60.92 $60.92 $0.00 $51.50 $81.58 $82.40 $0.00 $0.00 $0.00 $16.12 $0.00 $0.00 $16.40 $0.00 $0.00 $0.00 $0.00 $0.00 27202571 EAP HCPCS C2629 Introducer Tear Away 6f X 10cm BOTH IP/OP $159.00 $117.66 $0.00 $127.20 $0.00 $0.00 $0.00 $0.00 $0.00 $33.14 $118.01 $118.01 $122.56 $0.00 $33.14 $0.00 $94.05 $94.05 $0.00 $79.50 $125.93 $127.20 $0.00 $0.00 $0.00 $24.88 $0.00 $0.00 $25.31 $0.00 $0.00 $0.00 $0.00 $0.00 27202572 EAP HCPCS C1769 "Amplatz Sup Guidewire,035/75gw" BOTH IP/OP $331.00 $244.94 $0.00 $255.13 $179.73 $179.73 $0.00 $0.00 $0.00 $68.99 $245.67 $245.67 $255.13 $0.00 $68.98 $0.00 $195.79 $195.79 $0.00 $33.00 $52.27 $52.80 $0.00 $215.15 $0.00 $10.33 $0.00 $0.00 $10.51 $0.00 $0.00 $0.00 $0.00 $0.00 27202573 EAP HCPCS C1726 Merci Balloon Guide Catheter BOTH IP/OP "$2,251.00 " "$1,665.74" $0.00 "$1,800.80" "$1,222.29" "$1,222.29" $0.00 $0.00 $0.00 $469.16 "$1,670.69" "$1,670.69" "$1,735.07" $0.00 $469.11 $0.00 "$1,331.47" "$1,331.47" $0.00 "$1,125.50" "$1,782.79" "$1,800.80" $0.00 $0.00 $0.00 $352.28 $0.00 $0.00 $358.36 $0.00 $0.00 $0.00 $0.00 $0.00 27202574 EAP HCPCS C1751 Merci Microcatheter BOTH IP/OP "$1,641.00 " "$1,214.34" $0.00 "$1,312.80" $891.06 $891.06 $0.00 $0.00 $0.00 $342.03 "$1,217.95" "$1,217.95" "$1,264.88" $0.00 $341.98 $0.00 $970.65 $970.65 $0.00 $820.50 "$1,299.67" "$1,312.80" $0.00 $0.00 $0.00 $256.82 $0.00 $0.00 $261.25 $0.00 $0.00 $0.00 $0.00 $0.00 27202575 EAP HCPCS C1757 Meri V-series Retrieval V2.0 BOTH IP/OP "$10,341.00 " "$7,652.34" $0.00 "$8,272.80" "$5,615.16" "$5,615.16" $0.00 $0.00 $0.00 "$2,155.32" "$4,181.12" "$4,181.12" "$7,970.84" $0.00 "$2,155.06" $0.00 "$3,094.73" "$3,094.73" $0.00 "$5,170.50" "$8,190.07" "$8,272.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202576 EAP HCPCS C1757 Meri V-series Retrieval V2.5 BOTH IP/OP "$10,708.00 " "$7,923.92" $0.00 "$8,566.40" "$5,814.44" "$5,814.44" $0.00 $0.00 $0.00 "$2,231.81" "$4,181.12" "$4,181.12" "$8,253.73" $0.00 "$2,231.55" $0.00 "$3,094.73" "$3,094.73" $0.00 "$5,354.00" "$8,480.74" "$8,566.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202577 EAP HCPCS C1757 Meri V-series Retrieval V3.0 BOTH IP/OP "$10,708.00 " "$7,923.92" $0.00 "$8,566.40" "$5,814.44" "$5,814.44" $0.00 $0.00 $0.00 "$2,231.81" "$4,181.12" "$4,181.12" "$8,253.73" $0.00 "$2,231.55" $0.00 "$3,094.73" "$3,094.73" $0.00 "$5,354.00" "$8,480.74" "$8,566.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202578 EAP HCPCS C1757 Meri V-series Retrieval V2.5 BOTH IP/OP "$10,341.00 " "$7,652.34" $0.00 "$8,272.80" "$5,615.16" "$5,615.16" $0.00 $0.00 $0.00 "$2,155.32" "$4,181.12" "$4,181.12" "$7,970.84" $0.00 "$2,155.06" $0.00 "$3,094.73" "$3,094.73" $0.00 "$5,170.50" "$8,190.07" "$8,272.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202579 EAP HCPCS C1751 Catheter Reperfusion 026 BOTH IP/OP "$3,767.00 " "$2,787.58" $0.00 "$3,013.60" "$2,045.48" "$2,045.48" $0.00 $0.00 $0.00 $785.14 "$2,795.87" "$2,795.87" "$2,903.60" $0.00 $785.04 $0.00 "$2,228.18" "$2,228.18" $0.00 "$1,883.50" "$2,983.46" "$3,013.60" $0.00 $0.00 $0.00 $589.54 $0.00 $0.00 $599.71 $0.00 $0.00 $0.00 $0.00 $0.00 27202580 EAP HCPCS C1751 Catheter Reperfusion 032 BOTH IP/OP "$3,635.00 " "$2,689.90" $0.00 "$2,908.00" "$1,973.81" "$1,973.81" $0.00 $0.00 $0.00 $757.62 "$2,697.90" "$2,697.90" "$2,801.86" $0.00 $757.53 $0.00 "$2,150.10" "$2,150.10" $0.00 "$1,817.50" "$2,878.92" "$2,908.00" $0.00 $0.00 $0.00 $568.88 $0.00 $0.00 $578.69 $0.00 $0.00 $0.00 $0.00 $0.00 27202581 EAP HCPCS C1751 Catheter Reperfusion 041 BOTH IP/OP "$3,635.00 " "$2,689.90" $0.00 "$2,908.00" "$1,973.81" "$1,973.81" $0.00 $0.00 $0.00 $757.62 "$2,697.90" "$2,697.90" "$2,801.86" $0.00 $757.53 $0.00 "$2,150.10" "$2,150.10" $0.00 "$1,817.50" "$2,878.92" "$2,908.00" $0.00 $0.00 $0.00 $568.88 $0.00 $0.00 $578.69 $0.00 $0.00 $0.00 $0.00 $0.00 27202582 EAP Custom 27202582 Separator 026 BOTH IP/OP "$7,910.00 " "$5,853.40" $0.00 "$6,328.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$6,097.03" $0.00 "$1,648.44" $0.00 $0.00 $0.00 $0.00 "$3,955.00" "$6,264.72" "$6,328.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202583 EAP Custom 27202583 Separator 032 BOTH IP/OP "$7,639.00 " "$5,652.86" $0.00 "$6,111.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,888.14" $0.00 "$1,591.97" $0.00 $0.00 $0.00 $0.00 "$3,819.50" "$6,050.09" "$6,111.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202584 EAP Custom 27202584 Separator 041 BOTH IP/OP "$7,639.00 " "$5,652.86" $0.00 "$6,111.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$5,888.14" $0.00 "$1,591.97" $0.00 $0.00 $0.00 $0.00 "$3,819.50" "$6,050.09" "$6,111.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202585 EAP Custom 27202585 "Tubing, Aspiration" BOTH IP/OP "$1,279.00 " $946.46 $0.00 "$1,023.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $949.27 $949.27 $985.85 $0.00 $266.54 $0.00 $0.00 $0.00 $0.00 $639.50 "$1,012.97" "$1,023.20" $0.00 $831.35 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202586 EAP Custom 27202586 "Pump, Penumbra Aspiration" BOTH IP/OP "$8,340.00 " "$6,171.60" $0.00 "$6,672.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$6,428.47" $0.00 "$1,738.06" $0.00 $0.00 $0.00 $0.00 "$4,170.00" "$6,605.28" "$6,672.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202587 EAP HCPCS C1751 "Microcatheter, Microvention" BOTH IP/OP "$2,353.00 " "$1,741.22" $0.00 "$1,882.40" "$1,277.68" "$1,277.68" $0.00 $0.00 $0.00 $490.42 "$1,746.40" "$1,746.40" "$1,813.69" $0.00 $490.37 $0.00 "$1,391.80" "$1,391.80" $0.00 "$1,176.50" "$1,863.58" "$1,882.40" $0.00 $0.00 $0.00 $368.24 $0.00 $0.00 $374.60 $0.00 $0.00 $0.00 $0.00 $0.00 27202588 EAP Custom 27202588 "Controller, V-grip Detachment" BOTH IP/OP $560.00 $414.40 $0.00 $448.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $415.63 $415.63 $431.65 $0.00 $116.70 $0.00 $0.00 $0.00 $0.00 $280.00 $443.52 $448.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202589 EAP HCPCS C1751 "Catheter, Echelon Micro" BOTH IP/OP "$2,072.00 " "$1,533.28" $0.00 "$1,657.60" "$1,125.10" "$1,125.10" $0.00 $0.00 $0.00 $431.86 "$1,537.84" "$1,537.84" "$1,597.10" $0.00 $431.80 $0.00 "$1,225.59" "$1,225.59" $0.00 "$1,036.00" "$1,641.02" "$1,657.60" $0.00 $0.00 $0.00 $324.27 $0.00 $0.00 $329.86 $0.00 $0.00 $0.00 $0.00 $0.00 27202590 EAP HCPCS C1726 "Balloon, Hyperform 4mm X 7mm" BOTH IP/OP "$4,005.00 " "$2,963.70" $0.00 "$3,204.00" "$2,174.72" "$2,174.72" $0.00 $0.00 $0.00 $834.74 "$2,972.51" "$2,972.51" "$3,087.05" $0.00 $834.64 $0.00 "$2,368.96" "$2,368.96" $0.00 "$2,002.50" "$3,171.96" "$3,204.00" $0.00 $0.00 $0.00 $626.78 $0.00 $0.00 $637.60 $0.00 $0.00 $0.00 $0.00 $0.00 27202591 EAP HCPCS C1726 "Balloon, Hyperform 7mm X 7mm" BOTH IP/OP "$4,005.00 " "$2,963.70" $0.00 "$3,204.00" "$2,174.72" "$2,174.72" $0.00 $0.00 $0.00 $834.74 "$2,972.51" "$2,972.51" "$3,087.05" $0.00 $834.64 $0.00 "$2,368.96" "$2,368.96" $0.00 "$2,002.50" "$3,171.96" "$3,204.00" $0.00 "$2,603.25" $0.00 $626.78 $0.00 $0.00 $637.60 $0.00 $0.00 $0.00 $0.00 $0.00 27202592 EAP HCPCS C1726 "Balloon, Hyperglide 4mm X 15mm" BOTH IP/OP "$3,336.00 " "$2,468.64" $0.00 "$2,668.80" "$1,811.45" "$1,811.45" $0.00 $0.00 $0.00 $695.31 "$2,475.98" "$2,475.98" "$2,571.39" $0.00 $695.22 $0.00 "$1,973.24" "$1,973.24" $0.00 "$1,668.00" "$2,642.11" "$2,668.80" $0.00 $0.00 $0.00 $522.08 $0.00 $0.00 $531.09 $0.00 $0.00 $0.00 $0.00 $0.00 27202593 EAP HCPCS C1887 "Catheter, Envoy 6f Guiding" BOTH IP/OP $884.00 $654.16 $0.00 $707.20 $480.01 $480.01 $0.00 $0.00 $0.00 $184.25 $656.10 $656.10 $681.39 $0.00 $184.23 $0.00 $522.89 $522.89 $0.00 $442.00 $700.13 $707.20 $0.00 $574.60 $0.00 $138.35 $0.00 $0.00 $140.73 $0.00 $0.00 $0.00 $0.00 $0.00 27202594 EAP HCPCS C1751 "Microcatheter, Rapidtransit" BOTH IP/OP "$2,002.00 " "$1,481.48" $0.00 "$1,601.60" "$1,087.09" "$1,087.09" $0.00 $0.00 $0.00 $417.27 "$1,485.88" "$1,485.88" "$1,543.14" $0.00 $417.22 $0.00 "$1,184.18" "$1,184.18" $0.00 "$1,001.00" "$1,585.58" "$1,601.60" $0.00 $0.00 $0.00 $313.31 $0.00 $0.00 $318.72 $0.00 $0.00 $0.00 $0.00 $0.00 27202595 EAP Custom 27202595 "System,trufill N-bca Liquid Em" BOTH IP/OP $281.00 $207.94 $0.00 $224.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $208.56 $208.56 $216.59 $0.00 $58.56 $0.00 $0.00 $0.00 $0.00 $140.50 $222.55 $224.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202596 EAP HCPCS C1887 "Catheter, Envoy Xb Guiding" BOTH IP/OP $988.00 $731.12 $0.00 $790.40 $536.48 $536.48 $0.00 $0.00 $0.00 $205.92 $733.29 $733.29 $761.55 $0.00 $205.90 $0.00 $584.40 $584.40 $0.00 $494.00 $782.50 $790.40 $0.00 $0.00 $0.00 $154.62 $0.00 $0.00 $157.29 $0.00 $0.00 $0.00 $0.00 $0.00 27202597 EAP HCPCS C1751 "Microcatheter, Prowler" BOTH IP/OP "$2,169.00 " "$1,605.06" $0.00 "$1,735.20" "$1,177.77" "$1,177.77" $0.00 $0.00 $0.00 $452.07 "$1,609.83" "$1,609.83" "$1,671.87" $0.00 $452.02 $0.00 "$1,282.96" "$1,282.96" $0.00 "$1,084.50" "$1,717.85" "$1,735.20" $0.00 $0.00 $0.00 $339.45 $0.00 $0.00 $345.30 $0.00 $0.00 $0.00 $0.00 $0.00 27202598 EAP HCPCS C1751 "Microcatheter, Prowler" BOTH IP/OP "$2,277.00 " "$1,684.98" $0.00 "$1,821.60" "$1,236.41" "$1,236.41" $0.00 $0.00 $0.00 $474.58 "$1,689.99" "$1,689.99" "$1,755.11" $0.00 $474.53 $0.00 "$1,346.85" "$1,346.85" $0.00 "$1,138.50" "$1,803.38" "$1,821.60" $0.00 $0.00 $0.00 $356.35 $0.00 $0.00 $362.50 $0.00 $0.00 $0.00 $0.00 $0.00 27202599 EAP HCPCS C1769 Guidewire Bentson .038 260 Exc BOTH IP/OP $88.00 $65.12 $0.00 $70.40 $47.78 $47.78 $0.00 $0.00 $0.00 $18.34 $65.31 $65.31 $67.83 $0.00 $18.34 $0.00 $52.05 $52.05 $0.00 $44.00 $69.70 $70.40 $0.00 $0.00 $0.00 $13.77 $0.00 $0.00 $14.01 $0.00 $0.00 $0.00 $0.00 $0.00 27202600 EAP HCPCS C1769 Guidwire Glide .038 150 Angle BOTH IP/OP $154.00 $113.96 $0.00 $123.20 $83.62 $83.62 $0.00 $0.00 $0.00 $32.10 $114.30 $114.30 $118.70 $0.00 $32.09 $0.00 $91.09 $91.09 $0.00 $77.00 $121.97 $123.20 $0.00 $100.10 $0.00 $24.10 $0.00 $0.00 $24.52 $0.00 $0.00 $0.00 $0.00 $0.00 27202601 EAP HCPCS C1769 Guidwire Glide .038 180 Angle BOTH IP/OP $37.00 $27.38 $0.00 $29.60 $20.09 $20.09 $0.00 $0.00 $0.00 $7.71 $27.46 $27.46 $28.52 $0.00 $7.71 $0.00 $21.89 $21.89 $0.00 $18.50 $29.30 $29.60 $0.00 $0.00 $0.00 $5.79 $0.00 $0.00 $5.89 $0.00 $0.00 $0.00 $0.00 $0.00 27202602 EAP HCPCS C1769 Guidewire Transend Ex .014 BOTH IP/OP "$1,036.00 " $766.64 $0.00 $828.80 $562.55 $562.55 $0.00 $0.00 $0.00 $215.93 $768.92 $768.92 $798.55 $0.00 $215.90 $0.00 $612.79 $612.79 $0.00 $518.00 $820.51 $828.80 $0.00 $0.00 $0.00 $162.13 $0.00 $0.00 $164.93 $0.00 $0.00 $0.00 $0.00 $0.00 27202603 EAP HCPCS C1769 Guidewire Transend Ex .014st BOTH IP/OP "$1,036.00 " $766.64 $0.00 $828.80 $562.55 $562.55 $0.00 $0.00 $0.00 $215.93 $768.92 $768.92 $798.55 $0.00 $215.90 $0.00 $612.79 $612.79 $0.00 $518.00 $820.51 $828.80 $0.00 $673.40 $0.00 $162.13 $0.00 $0.00 $164.93 $0.00 $0.00 $0.00 $0.00 $0.00 27202604 EAP HCPCS C1769 Guidewire Transend Es 300cm BOTH IP/OP "$1,320.00 " $976.80 $0.00 "$1,056.00" $716.76 $716.76 $0.00 $0.00 $0.00 $275.12 $979.70 $979.70 "$1,017.46" $0.00 $275.09 $0.00 $780.78 $780.78 $0.00 $660.00 "$1,045.44" "$1,056.00" $0.00 $0.00 $0.00 $206.58 $0.00 $0.00 $210.14 $0.00 $0.00 $0.00 $0.00 $0.00 27202605 EAP HCPCS C1887 "Catheter, 7fr Guider Softip" BOTH IP/OP $667.00 $493.58 $0.00 $533.60 $362.18 $362.18 $0.00 $0.00 $0.00 $139.02 $495.05 $495.05 $514.12 $0.00 $139.00 $0.00 $394.53 $394.53 $0.00 $333.50 $528.26 $533.60 $0.00 $0.00 $0.00 $104.39 $0.00 $0.00 $106.19 $0.00 $0.00 $0.00 $0.00 $0.00 27202606 EAP HCPCS C1751 "Catheter, Renegade Micro" BOTH IP/OP "$1,202.00 " $889.48 $0.00 $961.60 $652.69 $652.69 $0.00 $0.00 $0.00 $250.53 $892.12 $892.12 $926.50 $0.00 $250.50 $0.00 $710.98 $710.98 $0.00 $601.00 $951.98 $961.60 $0.00 $0.00 $0.00 $188.11 $0.00 $0.00 $191.36 $0.00 $0.00 $0.00 $0.00 $0.00 27202607 EAP HCPCS C1751 "Microcatheter, Excelsior 1018" BOTH IP/OP "$2,169.00 " "$1,605.06" $0.00 "$1,735.20" "$1,177.77" "$1,177.77" $0.00 $0.00 $0.00 $452.07 "$1,609.83" "$1,609.83" "$1,671.87" $0.00 $452.02 $0.00 "$1,282.96" "$1,282.96" $0.00 "$1,084.50" "$1,717.85" "$1,735.20" $0.00 $0.00 $0.00 $339.45 $0.00 $0.00 $345.30 $0.00 $0.00 $0.00 $0.00 $0.00 27202608 EAP HCPCS C1769 "Guidewire, Synchro2" BOTH IP/OP "$1,251.00 " $925.74 $0.00 "$1,000.80" $679.29 $679.29 $0.00 $0.00 $0.00 $260.74 $928.49 $928.49 $964.27 $0.00 $260.71 $0.00 $739.97 $739.97 $0.00 $625.50 $990.79 "$1,000.80" $0.00 $813.15 $0.00 $195.78 $0.00 $0.00 $199.16 $0.00 $0.00 $0.00 $0.00 $0.00 27202609 EAP Custom 27202609 26x12x12cm Aaa Endoprosthesis BOTH IP/OP "$23,752.00 " "$17,576.48" $0.00 "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$18,308.04" $0.00 "$4,949.92" $0.00 $0.00 $0.00 $0.00 "$11,876.00" "$18,811.58" "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202610 EAP Custom 27202610 26x12x14cm Aaa Endoprosthesis BOTH IP/OP "$23,752.00 " "$17,576.48" $0.00 "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$18,308.04" $0.00 "$4,949.92" $0.00 $0.00 $0.00 $0.00 "$11,876.00" "$18,811.58" "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202611 EAP Custom 27202611 12x12x13.5cm Lliac Limb Aaa St BOTH IP/OP "$21,112.00 " "$15,622.88" $0.00 "$16,889.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$16,273.13" $0.00 "$4,399.74" $0.00 $0.00 $0.00 $0.00 "$10,556.00" "$16,720.70" "$16,889.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202612 EAP Custom 27202612 18x24x13.5cm Iliac Limb Aaa St BOTH IP/OP "$24,857.00 " "$18,394.18" $0.00 "$19,885.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$19,159.78" $0.00 "$5,180.20" $0.00 $0.00 $0.00 $0.00 "$12,428.50" "$19,686.74" "$19,885.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202613 EAP HCPCS C1751 Cath 6fr 1lum Try 3cg Shrlk Maximal Brr Picc P BOTH IP/OP "$1,010.00 " $747.40 $0.00 $808.00 $548.43 $548.43 $0.00 $0.00 $0.00 $210.51 $749.62 $749.62 $778.51 $0.00 $210.48 $0.00 $597.42 $597.42 $0.00 $505.00 $799.92 $808.00 $0.00 $656.50 $0.00 $158.07 $0.00 $0.00 $160.79 $0.00 $0.00 $0.00 $0.00 $0.00 27202614 EAP Custom 27202614 "Cather, Balloon, Ultra-thin Di" BOTH IP/OP "$1,580.00 " "$1,169.20" $0.00 "$1,264.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $790.00 "$1,251.36" "$1,264.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202615 EAP Custom 27202615 23x12x12cm Aaa Endoprosthesis BOTH IP/OP "$23,752.00 " "$17,576.48" $0.00 "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$18,308.04" $0.00 "$4,949.92" $0.00 $0.00 $0.00 $0.00 "$11,876.00" "$18,811.58" "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202616 EAP Custom 27202616 23x12x14cm Aaa Endoprosthesis BOTH IP/OP "$23,752.00 " "$17,576.48" $0.00 "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$18,308.04" $0.00 "$4,949.92" $0.00 $0.00 $0.00 $0.00 "$11,876.00" "$18,811.58" "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202617 EAP Custom 27202617 23x12x16cm Aaa Endoprosthesis BOTH IP/OP "$23,752.00 " "$17,576.48" $0.00 "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$18,308.04" $0.00 "$4,949.92" $0.00 $0.00 $0.00 $0.00 "$11,876.00" "$18,811.58" "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202618 EAP Custom 27202618 23x12x18cm Aaa Endoprosthesis BOTH IP/OP "$23,752.00 " "$17,576.48" $0.00 "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$18,308.04" $0.00 "$4,949.92" $0.00 $0.00 $0.00 $0.00 "$11,876.00" "$18,811.58" "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202619 EAP Custom 27202619 23x14.5x12cm Aaa Endoprosthesi BOTH IP/OP "$23,752.00 " "$17,576.48" $0.00 "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$18,308.04" $0.00 "$4,949.92" $0.00 $0.00 $0.00 $0.00 "$11,876.00" "$18,811.58" "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202620 EAP Custom 27202620 23x14.5x14cm Aaa Endoprosthesi BOTH IP/OP "$23,752.00 " "$17,576.48" $0.00 "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$18,308.04" $0.00 "$4,949.92" $0.00 $0.00 $0.00 $0.00 "$11,876.00" "$18,811.58" "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202621 EAP Custom 27202621 23x14.5x16cm Aaa Endoprosthesi BOTH IP/OP "$23,752.00 " "$17,576.48" $0.00 "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$18,308.04" $0.00 "$4,949.92" $0.00 $0.00 $0.00 $0.00 "$11,876.00" "$18,811.58" "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202622 EAP Custom 27202622 23x14.5x18cm Aaa Endoprosthesi BOTH IP/OP "$23,752.00 " "$17,576.48" $0.00 "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$18,308.04" $0.00 "$4,949.92" $0.00 $0.00 $0.00 $0.00 "$11,876.00" "$18,811.58" "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202623 EAP Custom 27202623 26x12x12cm Aaa Endoprosthesis BOTH IP/OP "$23,752.00 " "$17,576.48" $0.00 "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$18,308.04" $0.00 "$4,949.92" $0.00 $0.00 $0.00 $0.00 "$11,876.00" "$18,811.58" "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202624 EAP Custom 27202624 26x12x14cm Aaa Endoprosthesis BOTH IP/OP "$23,752.00 " "$17,576.48" $0.00 "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$18,308.04" $0.00 "$4,949.92" $0.00 $0.00 $0.00 $0.00 "$11,876.00" "$18,811.58" "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202625 EAP Custom 27202625 26x12x16cm Aaa Endoprosthesis BOTH IP/OP "$23,752.00 " "$17,576.48" $0.00 "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$18,308.04" $0.00 "$4,949.92" $0.00 $0.00 $0.00 $0.00 "$11,876.00" "$18,811.58" "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202626 EAP Custom 27202626 26x12x18cm Aaa Endoprosthesis BOTH IP/OP "$23,752.00 " "$17,576.48" $0.00 "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$18,308.04" $0.00 "$4,949.92" $0.00 $0.00 $0.00 $0.00 "$11,876.00" "$18,811.58" "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202627 EAP Custom 27202627 26x14.5x12cm Aaa Endoprosthesi BOTH IP/OP "$23,752.00 " "$17,576.48" $0.00 "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$18,308.04" $0.00 "$4,949.92" $0.00 $0.00 $0.00 $0.00 "$11,876.00" "$18,811.58" "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202628 EAP Custom 27202628 26x14.5x14cm Aaa Endoprosthesi BOTH IP/OP "$23,752.00 " "$17,576.48" $0.00 "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$18,308.04" $0.00 "$4,949.92" $0.00 $0.00 $0.00 $0.00 "$11,876.00" "$18,811.58" "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202629 EAP Custom 27202629 26x14.5x16cm Aaa Endoprosthesi BOTH IP/OP "$23,752.00 " "$17,576.48" $0.00 "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$18,308.04" $0.00 "$4,949.92" $0.00 $0.00 $0.00 $0.00 "$11,876.00" "$18,811.58" "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202630 EAP Custom 27202630 26x14.4x18cm Aaa Endoprosthesi BOTH IP/OP "$25,581.00 " "$18,929.94" $0.00 "$20,464.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$19,717.83" $0.00 "$5,331.08" $0.00 $0.00 $0.00 $0.00 "$12,790.50" "$20,260.15" "$20,464.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202631 EAP Custom 27202631 28.5x12x12cm Aaa Endoprosthesi BOTH IP/OP "$23,752.00 " "$17,576.48" $0.00 "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$18,308.04" $0.00 "$4,949.92" $0.00 $0.00 $0.00 $0.00 "$11,876.00" "$18,811.58" "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202632 EAP Custom 27202632 28.5x12x14cm Aaa Endoprosthesi BOTH IP/OP "$23,752.00 " "$17,576.48" $0.00 "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$18,308.04" $0.00 "$4,949.92" $0.00 $0.00 $0.00 $0.00 "$11,876.00" "$18,811.58" "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202633 EAP Custom 27202633 28.5x12x16cm Aaa Endoprosthesi BOTH IP/OP "$23,752.00 " "$17,576.48" $0.00 "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$18,308.04" $0.00 "$4,949.92" $0.00 $0.00 $0.00 $0.00 "$11,876.00" "$18,811.58" "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202634 EAP Custom 27202634 28.5x12x18cm Aaa Endoprosthesi BOTH IP/OP "$23,752.00 " "$17,576.48" $0.00 "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$18,308.04" $0.00 "$4,949.92" $0.00 $0.00 $0.00 $0.00 "$11,876.00" "$18,811.58" "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202635 EAP Custom 27202635 28.5x14.5x12cm Aaa Endoprosthe BOTH IP/OP "$23,752.00 " "$17,576.48" $0.00 "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$18,308.04" $0.00 "$4,949.92" $0.00 $0.00 $0.00 $0.00 "$11,876.00" "$18,811.58" "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202636 EAP Custom 27202636 28.5x14.5x14cm Aaa Endoprosthe BOTH IP/OP "$23,752.00 " "$17,576.48" $0.00 "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$18,308.04" $0.00 "$4,949.92" $0.00 $0.00 $0.00 $0.00 "$11,876.00" "$18,811.58" "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202637 EAP Custom 27202637 28.5x14.5x16cm Aaa Endoprosthe BOTH IP/OP "$23,752.00 " "$17,576.48" $0.00 "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$18,308.04" $0.00 "$4,949.92" $0.00 $0.00 $0.00 $0.00 "$11,876.00" "$18,811.58" "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202638 EAP Custom 27202638 28.5x14.4x18cm Aaa Endoprosthe BOTH IP/OP "$23,752.00 " "$17,576.48" $0.00 "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$18,308.04" $0.00 "$4,949.92" $0.00 $0.00 $0.00 $0.00 "$11,876.00" "$18,811.58" "$19,001.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202639 EAP Custom 27202639 12x10cm Aaa Endoprosthesis BOTH IP/OP "$22,940.00 " "$16,975.60" $0.00 "$18,352.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,682.15" $0.00 "$4,780.70" $0.00 $0.00 $0.00 $0.00 "$11,470.00" "$18,168.48" "$18,352.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202640 EAP Custom 27202640 12x12cm Aaa Endoprosthesis BOTH IP/OP "$22,940.00 " "$16,975.60" $0.00 "$18,352.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,682.15" $0.00 "$4,780.70" $0.00 $0.00 $0.00 $0.00 "$11,470.00" "$18,168.48" "$18,352.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202641 EAP Custom 27202641 12x14cm Aaa Endoprosthesis BOTH IP/OP "$22,940.00 " "$16,975.60" $0.00 "$18,352.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,682.15" $0.00 "$4,780.70" $0.00 $0.00 $0.00 $0.00 "$11,470.00" "$18,168.48" "$18,352.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202642 EAP Custom 27202642 14.5x10cm Aaa Endoprosthesis BOTH IP/OP "$22,940.00 " "$16,975.60" $0.00 "$18,352.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,682.15" $0.00 "$4,780.70" $0.00 $0.00 $0.00 $0.00 "$11,470.00" "$18,168.48" "$18,352.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202643 EAP Custom 27202643 14.4x12 Aaa Endoprosthesis BOTH IP/OP "$22,940.00 " "$16,975.60" $0.00 "$18,352.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,682.15" $0.00 "$4,780.70" $0.00 $0.00 $0.00 $0.00 "$11,470.00" "$18,168.48" "$18,352.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202644 EAP Custom 27202644 14.5x14 Aaa Endoprosthesis BOTH IP/OP "$22,940.00 " "$16,975.60" $0.00 "$18,352.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,682.15" $0.00 "$4,780.70" $0.00 $0.00 $0.00 $0.00 "$11,470.00" "$18,168.48" "$18,352.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202645 EAP Custom 27202645 16x9.5cm Aaa Endoprosthesis BOTH IP/OP "$22,940.00 " "$16,975.60" $0.00 "$18,352.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,682.15" $0.00 "$4,780.70" $0.00 $0.00 $0.00 $0.00 "$11,470.00" "$18,168.48" "$18,352.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202646 EAP Custom 27202646 16x11.5cm Aaa Endoprosthesis BOTH IP/OP "$22,940.00 " "$16,975.60" $0.00 "$18,352.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,682.15" $0.00 "$4,780.70" $0.00 $0.00 $0.00 $0.00 "$11,470.00" "$18,168.48" "$18,352.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202647 EAP Custom 27202647 16x13.5cm Aaa Endoprosthesis BOTH IP/OP "$22,940.00 " "$16,975.60" $0.00 "$18,352.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,682.15" $0.00 "$4,780.70" $0.00 $0.00 $0.00 $0.00 "$11,470.00" "$18,168.48" "$18,352.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202648 EAP Custom 27202648 18x9.5cm Aaa Endoprosthesis BOTH IP/OP "$22,940.00 " "$16,975.60" $0.00 "$18,352.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,682.15" $0.00 "$4,780.70" $0.00 $0.00 $0.00 $0.00 "$11,470.00" "$18,168.48" "$18,352.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202649 EAP Custom 27202649 18x11.5cm Aaa Endoprosthesis BOTH IP/OP "$22,940.00 " "$16,975.60" $0.00 "$18,352.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,682.15" $0.00 "$4,780.70" $0.00 $0.00 $0.00 $0.00 "$11,470.00" "$18,168.48" "$18,352.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202650 EAP Custom 27202650 18x13.5cm Aaa Endoprosthesis BOTH IP/OP "$22,940.00 " "$16,975.60" $0.00 "$18,352.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,682.15" $0.00 "$4,780.70" $0.00 $0.00 $0.00 $0.00 "$11,470.00" "$18,168.48" "$18,352.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202651 EAP Custom 27202651 20x9.5cm Aaa Endoprosthesis BOTH IP/OP "$22,940.00 " "$16,975.60" $0.00 "$18,352.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,682.15" $0.00 "$4,780.70" $0.00 $0.00 $0.00 $0.00 "$11,470.00" "$18,168.48" "$18,352.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202652 EAP Custom 27202652 20x11.5cm Aaa Endoprosthesis BOTH IP/OP "$22,940.00 " "$16,975.60" $0.00 "$18,352.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,682.15" $0.00 "$4,780.70" $0.00 $0.00 $0.00 $0.00 "$11,470.00" "$18,168.48" "$18,352.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202653 EAP Custom 27202653 20x13.5cm Aaa Endoprosthesis BOTH IP/OP "$22,940.00 " "$16,975.60" $0.00 "$18,352.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,682.15" $0.00 "$4,780.70" $0.00 $0.00 $0.00 $0.00 "$11,470.00" "$18,168.48" "$18,352.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202654 EAP Custom 27202654 12x12x8.5cm Iliac Limb Aaa Ste BOTH IP/OP "$18,214.00 " "$13,478.36" $0.00 "$14,571.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$14,039.35" $0.00 "$3,795.80" $0.00 $0.00 $0.00 $0.00 "$9,107.00" "$14,425.49" "$14,571.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202655 EAP Custom 27202655 13x13x8.5cm Iliac Limb Aaa Ste BOTH IP/OP "$18,214.00 " "$13,478.36" $0.00 "$14,571.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$14,039.35" $0.00 "$3,795.80" $0.00 $0.00 $0.00 $0.00 "$9,107.00" "$14,425.49" "$14,571.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202656 EAP Custom 27202656 14x14x8.5cm Iliac Limb Aaa Ste BOTH IP/OP "$18,214.00 " "$13,478.36" $0.00 "$14,571.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$14,039.35" $0.00 "$3,795.80" $0.00 $0.00 $0.00 $0.00 "$9,107.00" "$14,425.49" "$14,571.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202657 EAP Custom 27202657 15x15x8.5cm Iliac Limb Aaa Ste BOTH IP/OP "$18,214.00 " "$13,478.36" $0.00 "$14,571.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$14,039.35" $0.00 "$3,795.80" $0.00 $0.00 $0.00 $0.00 "$9,107.00" "$14,425.49" "$14,571.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202658 EAP Custom 27202658 16x16x8.5cm Iliac Limb Aaa Ste BOTH IP/OP "$18,214.00 " "$13,478.36" $0.00 "$14,571.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$14,039.35" $0.00 "$3,795.80" $0.00 $0.00 $0.00 $0.00 "$9,107.00" "$14,425.49" "$14,571.20" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202659 EAP Custom 27202659 18x18x8.5cm Iliac Limb Aaa Ste BOTH IP/OP "$18,898.00 " "$13,984.52" $0.00 "$15,118.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$14,566.58" $0.00 "$3,938.34" $0.00 $0.00 $0.00 $0.00 "$9,449.00" "$14,967.22" "$15,118.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202660 EAP Custom 27202660 20x20x8.5cm Iliac Limb Aaa Ste BOTH IP/OP "$18,898.00 " "$13,984.52" $0.00 "$15,118.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$14,566.58" $0.00 "$3,938.34" $0.00 $0.00 $0.00 $0.00 "$9,449.00" "$14,967.22" "$15,118.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202661 EAP Custom 27202661 12x12x11.5cm Iliac Limb Aaa St BOTH IP/OP "$19,236.00 " "$14,234.64" $0.00 "$15,388.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$14,827.11" $0.00 "$4,008.78" $0.00 $0.00 $0.00 $0.00 "$9,618.00" "$15,234.91" "$15,388.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202662 EAP Custom 27202662 13x13x11.5cmm Iliac Limb Aaa S BOTH IP/OP "$19,236.00 " "$14,234.64" $0.00 "$15,388.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$14,827.11" $0.00 "$4,008.78" $0.00 $0.00 $0.00 $0.00 "$9,618.00" "$15,234.91" "$15,388.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202663 EAP Custom 27202663 14x14x11.5cm Iliac Limb Aaa St BOTH IP/OP "$19,236.00 " "$14,234.64" $0.00 "$15,388.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$14,827.11" $0.00 "$4,008.78" $0.00 $0.00 $0.00 $0.00 "$9,618.00" "$15,234.91" "$15,388.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202664 EAP Custom 27202664 15x15x11.5cm Iliac Limb Aaa St BOTH IP/OP "$19,236.00 " "$14,234.64" $0.00 "$15,388.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$14,827.11" $0.00 "$4,008.78" $0.00 $0.00 $0.00 $0.00 "$9,618.00" "$15,234.91" "$15,388.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202665 EAP Custom 27202665 16x16x11.5cm Iliac Limb Aaa St BOTH IP/OP "$19,236.00 " "$14,234.64" $0.00 "$15,388.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$14,827.11" $0.00 "$4,008.78" $0.00 $0.00 $0.00 $0.00 "$9,618.00" "$15,234.91" "$15,388.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202666 EAP Custom 27202666 18x18x11.5cm Iliac Limb Aaa St BOTH IP/OP "$19,916.00 " "$14,737.84" $0.00 "$15,932.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$15,351.25" $0.00 "$4,150.49" $0.00 $0.00 $0.00 $0.00 "$9,958.00" "$15,773.47" "$15,932.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202667 EAP Custom 27202667 20x20x11.5cm Iliac Limb Aaa St BOTH IP/OP "$19,916.00 " "$14,737.84" $0.00 "$15,932.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$15,351.25" $0.00 "$4,150.49" $0.00 $0.00 $0.00 $0.00 "$9,958.00" "$15,773.47" "$15,932.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202668 EAP Custom 27202668 13x13x13.5cm Iliac Limb Aaa St BOTH IP/OP "$21,112.00 " "$15,622.88" $0.00 "$16,889.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$16,273.13" $0.00 "$4,399.74" $0.00 $0.00 $0.00 $0.00 "$10,556.00" "$16,720.70" "$16,889.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202669 EAP Custom 27202669 14x14x13.5cm Iliac Limb Aaa St BOTH IP/OP "$21,112.00 " "$15,622.88" $0.00 "$16,889.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$16,273.13" $0.00 "$4,399.74" $0.00 $0.00 $0.00 $0.00 "$10,556.00" "$16,720.70" "$16,889.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202670 EAP Custom 27202670 15x15x13.5cm Iliac Limb Aaa St BOTH IP/OP "$21,112.00 " "$15,622.88" $0.00 "$16,889.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$16,273.13" $0.00 "$4,399.74" $0.00 $0.00 $0.00 $0.00 "$10,556.00" "$16,720.70" "$16,889.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202671 EAP Custom 27202671 16x16x13.5cm Iliac Limb Aaa St BOTH IP/OP "$21,112.00 " "$15,622.88" $0.00 "$16,889.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$16,273.13" $0.00 "$4,399.74" $0.00 $0.00 $0.00 $0.00 "$10,556.00" "$16,720.70" "$16,889.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202672 EAP Custom 27202672 18x18x13.5cm Iliac Limb Aaa St BOTH IP/OP "$21,790.00 " "$16,124.60" $0.00 "$17,432.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$16,795.73" $0.00 "$4,541.04" $0.00 $0.00 $0.00 $0.00 "$10,895.00" "$17,257.68" "$17,432.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202673 EAP Custom 27202673 20x20x13.5cm Iliac Limb Aaa St BOTH IP/OP "$21,790.00 " "$16,124.60" $0.00 "$17,432.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$16,795.73" $0.00 "$4,541.04" $0.00 $0.00 $0.00 $0.00 "$10,895.00" "$17,257.68" "$17,432.00" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202674 EAP Custom 27202674 16x20x11.5cm Iliac Limb Aaa St BOTH IP/OP "$23,492.00 " "$17,384.08" $0.00 "$18,793.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$18,107.63" $0.00 "$4,895.73" $0.00 $0.00 $0.00 $0.00 "$11,746.00" "$18,605.66" "$18,793.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202675 EAP Custom 27202675 18x22x11.5cm Iliac Limb Aaa St BOTH IP/OP "$23,492.00 " "$17,384.08" $0.00 "$18,793.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$18,107.63" $0.00 "$4,895.73" $0.00 $0.00 $0.00 $0.00 "$11,746.00" "$18,605.66" "$18,793.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202676 EAP Custom 27202676 18x24x11.5cm Iliac Limb Aaa St BOTH IP/OP "$23,492.00 " "$17,384.08" $0.00 "$18,793.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$18,107.63" $0.00 "$4,895.73" $0.00 $0.00 $0.00 $0.00 "$11,746.00" "$18,605.66" "$18,793.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202677 EAP Custom 27202677 16x20x13.5cm Iliac Limb Aaa St BOTH IP/OP "$24,857.00 " "$18,394.18" $0.00 "$19,885.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$19,159.78" $0.00 "$5,180.20" $0.00 $0.00 $0.00 $0.00 "$12,428.50" "$19,686.74" "$19,885.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202678 EAP Custom 27202678 18x22x13.5cm Iliac Limb Aaa St BOTH IP/OP "$24,857.00 " "$18,394.18" $0.00 "$19,885.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$19,159.78" $0.00 "$5,180.20" $0.00 $0.00 $0.00 $0.00 "$12,428.50" "$19,686.74" "$19,885.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202679 EAP Custom 27202679 18x24x13.5cm Iliac Limb Aaa St BOTH IP/OP "$24,857.00 " "$18,394.18" $0.00 "$19,885.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$19,159.78" $0.00 "$5,180.20" $0.00 $0.00 $0.00 $0.00 "$12,428.50" "$19,686.74" "$19,885.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202680 EAP Custom 27202680 12x12x5.5cm Iliac Cuff Aaa Ste BOTH IP/OP "$15,151.00 " "$11,211.74" $0.00 "$12,120.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$11,678.39" $0.00 "$3,157.47" $0.00 $0.00 $0.00 $0.00 "$7,575.50" "$11,999.59" "$12,120.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202681 EAP Custom 27202681 13x13x5.5cm Ilaic Cuff Aaa Ste BOTH IP/OP "$15,151.00 " "$11,211.74" $0.00 "$12,120.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$11,678.39" $0.00 "$3,157.47" $0.00 $0.00 $0.00 $0.00 "$7,575.50" "$11,999.59" "$12,120.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202682 EAP Custom 27202682 14x14x5.5cm Iliac Cuff Aaa Ste BOTH IP/OP "$15,151.00 " "$11,211.74" $0.00 "$12,120.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$11,678.39" $0.00 "$3,157.47" $0.00 $0.00 $0.00 $0.00 "$7,575.50" "$11,999.59" "$12,120.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202683 EAP Custom 27202683 15x15x5.5cm Iliac Cuff Aaa Ste BOTH IP/OP "$15,151.00 " "$11,211.74" $0.00 "$12,120.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$11,678.39" $0.00 "$3,157.47" $0.00 $0.00 $0.00 $0.00 "$7,575.50" "$11,999.59" "$12,120.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202684 EAP Custom 27202684 16x15x5.5cm Iliac Cuff Aaa Ste BOTH IP/OP "$15,151.00 " "$11,211.74" $0.00 "$12,120.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$11,678.39" $0.00 "$3,157.47" $0.00 $0.00 $0.00 $0.00 "$7,575.50" "$11,999.59" "$12,120.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202685 EAP Custom 27202685 18x18x5.5cm Iliac Cuff Aaa Ste BOTH IP/OP "$15,832.00 " "$11,715.68" $0.00 "$12,665.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$12,203.31" $0.00 "$3,299.39" $0.00 $0.00 $0.00 $0.00 "$7,916.00" "$12,538.94" "$12,665.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202686 EAP Custom 27202686 20x20x5.5cm Iliac Cuff Aaa Ste BOTH IP/OP "$15,832.00 " "$11,715.68" $0.00 "$12,665.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$12,203.31" $0.00 "$3,299.39" $0.00 $0.00 $0.00 $0.00 "$7,916.00" "$12,538.94" "$12,665.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202687 EAP HCPCS C1769 6mmx5cmx110cm 0.035 Guidewire BOTH IP/OP "$15,219.00 " "$11,262.06" $0.00 "$12,175.20" "$8,263.92" "$8,263.92" $0.00 $0.00 $0.00 "$3,172.02" "$4,181.12" "$4,181.12" "$11,730.81" $0.00 "$3,171.64" $0.00 "$3,094.73" "$3,094.73" $0.00 "$7,609.50" "$12,053.45" "$12,175.20" $0.00 $0.00 $0.00 "$2,381.77" $0.00 $0.00 "$2,422.86" $0.00 $0.00 $0.00 $0.00 $0.00 27202688 EAP HCPCS C1769 6mmx10cmx110cm 0.035 Guidewire BOTH IP/OP "$18,251.00 " "$13,505.74" $0.00 "$14,600.80" "$9,910.29" "$9,910.29" $0.00 $0.00 $0.00 "$3,803.96" "$4,181.12" "$4,181.12" "$14,067.87" $0.00 "$3,803.51" $0.00 "$3,094.73" "$3,094.73" $0.00 "$9,125.50" "$14,454.79" "$14,600.80" $0.00 $0.00 $0.00 "$2,856.28" $0.00 $0.00 "$2,905.56" $0.00 $0.00 $0.00 $0.00 $0.00 27202689 EAP HCPCS C1769 6mmx15cmx110cm 0.035 Guidewire BOTH IP/OP "$21,246.00 " "$15,722.04" $0.00 "$16,996.80" "$11,536.58" "$11,536.58" $0.00 $0.00 $0.00 "$4,428.20" "$4,181.12" "$4,181.12" "$16,376.42" $0.00 "$4,427.67" $0.00 "$3,094.73" "$3,094.73" $0.00 "$10,623.00" "$16,826.83" "$16,996.80" $0.00 $0.00 $0.00 "$3,325.00" $0.00 $0.00 "$3,382.36" $0.00 $0.00 $0.00 $0.00 $0.00 27202690 EAP HCPCS C1769 7mmx5cmx110cm 0.035 Guidewire BOTH IP/OP "$15,219.00 " "$11,262.06" $0.00 "$12,175.20" "$8,263.92" "$8,263.92" $0.00 $0.00 $0.00 "$3,172.02" "$4,181.12" "$4,181.12" "$11,730.81" $0.00 "$3,171.64" $0.00 "$3,094.73" "$3,094.73" $0.00 "$7,609.50" "$12,053.45" "$12,175.20" $0.00 $0.00 $0.00 "$2,381.77" $0.00 $0.00 "$2,422.86" $0.00 $0.00 $0.00 $0.00 $0.00 27202691 EAP HCPCS C1769 7mmx10cmx110cm 0.035 Guidewire BOTH IP/OP "$18,251.00 " "$13,505.74" $0.00 "$14,600.80" "$9,910.29" "$9,910.29" $0.00 $0.00 $0.00 "$3,803.96" "$4,181.12" "$4,181.12" "$14,067.87" $0.00 "$3,803.51" $0.00 "$3,094.73" "$3,094.73" $0.00 "$9,125.50" "$14,454.79" "$14,600.80" $0.00 $0.00 $0.00 "$2,856.28" $0.00 $0.00 "$2,905.56" $0.00 $0.00 $0.00 $0.00 $0.00 27202692 EAP HCPCS C1769 7mmx15cmx110cm 0.035 Guidewire BOTH IP/OP "$21,246.00 " "$15,722.04" $0.00 "$16,996.80" "$11,536.58" "$11,536.58" $0.00 $0.00 $0.00 "$4,428.20" "$4,181.12" "$4,181.12" "$16,376.42" $0.00 "$4,427.67" $0.00 "$3,094.73" "$3,094.73" $0.00 "$10,623.00" "$16,826.83" "$16,996.80" $0.00 $0.00 $0.00 "$3,325.00" $0.00 $0.00 "$3,382.36" $0.00 $0.00 $0.00 $0.00 $0.00 27202693 EAP HCPCS C1769 8mmx5cmx110cm 0.035 Guidewire BOTH IP/OP "$15,219.00 " "$11,262.06" $0.00 "$12,175.20" "$8,263.92" "$8,263.92" $0.00 $0.00 $0.00 "$3,172.02" "$4,181.12" "$4,181.12" "$11,730.81" $0.00 "$3,171.64" $0.00 "$3,094.73" "$3,094.73" $0.00 "$7,609.50" "$12,053.45" "$12,175.20" $0.00 $0.00 $0.00 "$2,381.77" $0.00 $0.00 "$2,422.86" $0.00 $0.00 $0.00 $0.00 $0.00 27202694 EAP HCPCS C1769 8mmx10cmx110cm 0.035 Guidewire BOTH IP/OP "$18,251.00 " "$13,505.74" $0.00 "$14,600.80" "$9,910.29" "$9,910.29" $0.00 $0.00 $0.00 "$3,803.96" "$4,181.12" "$4,181.12" "$14,067.87" $0.00 "$3,803.51" $0.00 "$3,094.73" "$3,094.73" $0.00 "$9,125.50" "$14,454.79" "$14,600.80" $0.00 $0.00 $0.00 "$2,856.28" $0.00 $0.00 "$2,905.56" $0.00 $0.00 $0.00 $0.00 $0.00 27202695 EAP HCPCS C1769 8mmx15cmx110cm 0.035 Guidewire BOTH IP/OP "$21,246.00 " "$15,722.04" $0.00 "$16,996.80" "$11,536.58" "$11,536.58" $0.00 $0.00 $0.00 "$4,428.20" "$4,181.12" "$4,181.12" "$16,376.42" $0.00 "$4,427.67" $0.00 "$3,094.73" "$3,094.73" $0.00 "$10,623.00" "$16,826.83" "$16,996.80" $0.00 $0.00 $0.00 "$3,325.00" $0.00 $0.00 "$3,382.36" $0.00 $0.00 $0.00 $0.00 $0.00 27202696 EAP HCPCS C1769 10mmx5cmx110cm 0.025 Guidewire BOTH IP/OP "$15,219.00 " "$11,262.06" $0.00 "$12,175.20" "$8,263.92" "$8,263.92" $0.00 $0.00 $0.00 "$3,172.02" "$4,181.12" "$4,181.12" "$11,730.81" $0.00 "$3,171.64" $0.00 "$3,094.73" "$3,094.73" $0.00 "$7,609.50" "$12,053.45" "$12,175.20" $0.00 "$9,892.35" $0.00 "$2,381.77" $0.00 $0.00 "$2,422.86" $0.00 $0.00 $0.00 $0.00 $0.00 27202697 EAP HCPCS C1769 10mmx10cmx110cm 0.025 Guidewir BOTH IP/OP "$18,251.00 " "$13,505.74" $0.00 "$14,600.80" "$9,910.29" "$9,910.29" $0.00 $0.00 $0.00 "$3,803.96" "$4,181.12" "$4,181.12" "$14,067.87" $0.00 "$3,803.51" $0.00 "$3,094.73" "$3,094.73" $0.00 "$9,125.50" "$14,454.79" "$14,600.80" $0.00 "$11,863.15" $0.00 "$2,856.28" $0.00 $0.00 "$2,905.56" $0.00 $0.00 $0.00 $0.00 $0.00 27202698 EAP HCPCS C1769 13mmx5cmx110cm 0.025 Guidewire BOTH IP/OP "$15,219.00 " "$11,262.06" $0.00 "$12,175.20" "$8,263.92" "$8,263.92" $0.00 $0.00 $0.00 "$3,172.02" "$4,181.12" "$4,181.12" "$11,730.81" $0.00 "$3,171.64" $0.00 "$3,094.73" "$3,094.73" $0.00 "$7,609.50" "$12,053.45" "$12,175.20" $0.00 "$9,892.35" $0.00 "$2,381.77" $0.00 $0.00 "$2,422.86" $0.00 $0.00 $0.00 $0.00 $0.00 27202699 EAP HCPCS C1769 13mmx2.5cmx110cm 0.025 Guidewi BOTH IP/OP "$15,219.00 " "$11,262.06" $0.00 "$12,175.20" "$8,263.92" "$8,263.92" $0.00 $0.00 $0.00 "$3,172.02" "$4,181.12" "$4,181.12" "$11,730.81" $0.00 "$3,171.64" $0.00 "$3,094.73" "$3,094.73" $0.00 "$7,609.50" "$12,053.45" "$12,175.20" $0.00 $0.00 $0.00 "$2,381.77" $0.00 $0.00 "$2,422.86" $0.00 $0.00 $0.00 $0.00 $0.00 27202700 EAP Custom 27202700 16mmx20mmx8.5cm Aaa Stent Graf BOTH IP/OP "$22,131.00 " "$16,376.94" $0.00 "$17,704.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,058.57" $0.00 "$4,612.10" $0.00 $0.00 $0.00 $0.00 "$11,065.50" "$17,527.75" "$17,704.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202701 EAP Custom 27202701 18mmx22mmx8.5cm Aaa Stent Graf BOTH IP/OP "$22,131.00 " "$16,376.94" $0.00 "$17,704.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,058.57" $0.00 "$4,612.10" $0.00 $0.00 $0.00 $0.00 "$11,065.50" "$17,527.75" "$17,704.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202702 EAP Custom 27202702 18mmx24mmx8.5cm Aaa Stent Graf BOTH IP/OP "$22,131.00 " "$16,376.94" $0.00 "$17,704.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,058.57" $0.00 "$4,612.10" $0.00 $0.00 $0.00 $0.00 "$11,065.50" "$17,527.75" "$17,704.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202703 EAP Custom 27202703 20mmx4.0cm Aaa Stent Graft BOTH IP/OP "$15,151.00 " "$11,211.74" $0.00 "$12,120.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$11,678.39" $0.00 "$3,157.47" $0.00 $0.00 $0.00 $0.00 "$7,575.50" "$11,999.59" "$12,120.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202704 EAP Custom 27202704 22mmx4.0cm Aaa Stent Graft BOTH IP/OP "$15,151.00 " "$11,211.74" $0.00 "$12,120.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$11,678.39" $0.00 "$3,157.47" $0.00 $0.00 $0.00 $0.00 "$7,575.50" "$11,999.59" "$12,120.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202705 EAP Custom 27202705 24mmx4.0cm Aaa Stent Graft BOTH IP/OP "$15,151.00 " "$11,211.74" $0.00 "$12,120.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$11,678.39" $0.00 "$3,157.47" $0.00 $0.00 $0.00 $0.00 "$7,575.50" "$11,999.59" "$12,120.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202706 EAP Custom 27202706 26mmx4.0cm Aaa Stent Graft BOTH IP/OP "$15,151.00 " "$11,211.74" $0.00 "$12,120.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$11,678.39" $0.00 "$3,157.47" $0.00 $0.00 $0.00 $0.00 "$7,575.50" "$11,999.59" "$12,120.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202707 EAP Custom 27202707 28mmx4.0cm Aaa Stent Graft BOTH IP/OP "$15,151.00 " "$11,211.74" $0.00 "$12,120.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$11,678.39" $0.00 "$3,157.47" $0.00 $0.00 $0.00 $0.00 "$7,575.50" "$11,999.59" "$12,120.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202708 EAP Custom 27202708 23x3.3cm Aaa Endoprosthesis BOTH IP/OP "$17,322.00 " "$12,818.28" $0.00 "$13,857.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$13,351.80" $0.00 "$3,609.90" $0.00 $0.00 $0.00 $0.00 "$8,661.00" "$13,719.02" "$13,857.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202709 EAP Custom 27202709 26x3.3cm Aaa Endprosthesis BOTH IP/OP "$17,322.00 " "$12,818.28" $0.00 "$13,857.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$13,351.80" $0.00 "$3,609.90" $0.00 $0.00 $0.00 $0.00 "$8,661.00" "$13,719.02" "$13,857.60" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202710 EAP Custom 27202710 28.5x3.3cm Aaa Endoprosthesis BOTH IP/OP "$16,083.00 " "$11,901.42" $0.00 "$12,866.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$12,396.78" $0.00 "$3,351.70" $0.00 $0.00 $0.00 $0.00 "$8,041.50" "$12,737.74" "$12,866.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202711 EAP Custom 27202711 10x7cm Aaa Endoprosthesis BOTH IP/OP "$16,083.00 " "$11,901.42" $0.00 "$12,866.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$12,396.78" $0.00 "$3,351.70" $0.00 $0.00 $0.00 $0.00 "$8,041.50" "$12,737.74" "$12,866.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202712 EAP Custom 27202712 12x7cm Aaa Endoprosthesis BOTH IP/OP "$16,083.00 " "$11,901.42" $0.00 "$12,866.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$12,396.78" $0.00 "$3,351.70" $0.00 $0.00 $0.00 $0.00 "$8,041.50" "$12,737.74" "$12,866.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202713 EAP Custom 27202713 14.5x7cm Aaa Endoprosthesis BOTH IP/OP "$16,083.00 " "$11,901.42" $0.00 "$12,866.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$12,396.78" $0.00 "$3,351.70" $0.00 $0.00 $0.00 $0.00 "$8,041.50" "$12,737.74" "$12,866.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202714 EAP Custom 27202714 12frx30cm Introducer Sheath BOTH IP/OP $525.00 $388.50 $0.00 $420.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $389.66 $389.66 $404.67 $0.00 $109.41 $0.00 $0.00 $0.00 $0.00 $262.50 $415.80 $420.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202715 EAP Custom 27202715 18frx30cm Intruder Sheath BOTH IP/OP $902.00 $667.48 $0.00 $721.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $669.46 $669.46 $695.26 $0.00 $187.98 $0.00 $0.00 $0.00 $0.00 $451.00 $714.38 $721.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202716 EAP Custom 27202716 26x10cm Thoracic Endoprosthesi BOTH IP/OP "$23,023.00 " "$17,037.02" $0.00 "$18,418.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,746.13" $0.00 "$4,797.99" $0.00 $0.00 $0.00 $0.00 "$11,511.50" "$18,234.22" "$18,418.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202717 EAP Custom 27202717 28x10cm Thoracic Endoprosthesi BOTH IP/OP "$23,023.00 " "$17,037.02" $0.00 "$18,418.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,746.13" $0.00 "$4,797.99" $0.00 $0.00 $0.00 $0.00 "$11,511.50" "$18,234.22" "$18,418.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202718 EAP Custom 27202718 28x15cm Thoracic Endoprosthesi BOTH IP/OP "$23,023.00 " "$17,037.02" $0.00 "$18,418.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,746.13" $0.00 "$4,797.99" $0.00 $0.00 $0.00 $0.00 "$11,511.50" "$18,234.22" "$18,418.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202719 EAP Custom 27202719 31x10cm Thoracic Endoprosthesi BOTH IP/OP "$23,023.00 " "$17,037.02" $0.00 "$18,418.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,746.13" $0.00 "$4,797.99" $0.00 $0.00 $0.00 $0.00 "$11,511.50" "$18,234.22" "$18,418.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202720 EAP Custom 27202720 31x15cm Thoracic Endoprosthesi BOTH IP/OP "$23,023.00 " "$17,037.02" $0.00 "$18,418.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,746.13" $0.00 "$4,797.99" $0.00 $0.00 $0.00 $0.00 "$11,511.50" "$18,234.22" "$18,418.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202721 EAP Custom 27202721 34x10cm Thoracic Endoprosthesi BOTH IP/OP "$23,023.00 " "$17,037.02" $0.00 "$18,418.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,746.13" $0.00 "$4,797.99" $0.00 $0.00 $0.00 $0.00 "$11,511.50" "$18,234.22" "$18,418.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202722 EAP Custom 27202722 34x15cm Thoracic Endoprosthesi BOTH IP/OP "$23,023.00 " "$17,037.02" $0.00 "$18,418.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,746.13" $0.00 "$4,797.99" $0.00 $0.00 $0.00 $0.00 "$11,511.50" "$18,234.22" "$18,418.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202723 EAP Custom 27202723 34x20cm Thoracic Endoprosthesi BOTH IP/OP "$23,023.00 " "$17,037.02" $0.00 "$18,418.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,746.13" $0.00 "$4,797.99" $0.00 $0.00 $0.00 $0.00 "$11,511.50" "$18,234.22" "$18,418.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202724 EAP Custom 27202724 37x10cm Thoracic Endoprosthesi BOTH IP/OP "$23,023.00 " "$17,037.02" $0.00 "$18,418.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,746.13" $0.00 "$4,797.99" $0.00 $0.00 $0.00 $0.00 "$11,511.50" "$18,234.22" "$18,418.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202725 EAP Custom 27202725 37x15cm Thoracic Endoprosthesi BOTH IP/OP "$23,023.00 " "$17,037.02" $0.00 "$18,418.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,746.13" $0.00 "$4,797.99" $0.00 $0.00 $0.00 $0.00 "$11,511.50" "$18,234.22" "$18,418.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202726 EAP Custom 27202726 37x20cm Thoracic Endoprosthesi BOTH IP/OP "$23,023.00 " "$17,037.02" $0.00 "$18,418.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,746.13" $0.00 "$4,797.99" $0.00 $0.00 $0.00 $0.00 "$11,511.50" "$18,234.22" "$18,418.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202727 EAP Custom 27202727 40x10cm Thoracic Endoprosthesi BOTH IP/OP "$23,023.00 " "$17,037.02" $0.00 "$18,418.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,746.13" $0.00 "$4,797.99" $0.00 $0.00 $0.00 $0.00 "$11,511.50" "$18,234.22" "$18,418.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202728 EAP Custom 27202728 40x15cm Thoracic Endoprosthesi BOTH IP/OP "$23,023.00 " "$17,037.02" $0.00 "$18,418.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,746.13" $0.00 "$4,797.99" $0.00 $0.00 $0.00 $0.00 "$11,511.50" "$18,234.22" "$18,418.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202729 EAP Custom 27202729 40x20cm Thoracic Endoprosthesi BOTH IP/OP "$23,023.00 " "$17,037.02" $0.00 "$18,418.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$17,746.13" $0.00 "$4,797.99" $0.00 $0.00 $0.00 $0.00 "$11,511.50" "$18,234.22" "$18,418.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202730 EAP Custom 27202730 20frx30cm Introducer Sheath BOTH IP/OP "$2,043.00 " "$1,511.82" $0.00 "$1,634.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,516.31" "$1,516.31" "$1,574.74" $0.00 $425.76 $0.00 $0.00 $0.00 $0.00 "$1,021.50" "$1,618.06" "$1,634.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202731 EAP Custom 27202731 22frx30cm Introducer Sheath BOTH IP/OP "$2,043.00 " "$1,511.82" $0.00 "$1,634.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,516.31" "$1,516.31" "$1,574.74" $0.00 $425.76 $0.00 $0.00 $0.00 $0.00 "$1,021.50" "$1,618.06" "$1,634.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202732 EAP Custom 27202732 24frx30cm Introducer Sheath BOTH IP/OP "$2,043.00 " "$1,511.82" $0.00 "$1,634.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$1,516.31" "$1,516.31" "$1,574.74" $0.00 $425.76 $0.00 $0.00 $0.00 $0.00 "$1,021.50" "$1,618.06" "$1,634.40" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202733 EAP Custom 27202733 Gore Tri-lobe Ballon Catheter BOTH IP/OP "$3,391.00 " "$2,509.34" $0.00 "$2,712.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$2,516.80" "$2,516.80" "$2,613.78" $0.00 $706.68 $0.00 $0.00 $0.00 $0.00 "$1,695.50" "$2,685.67" "$2,712.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202734 EAP Custom 27202734 20x12x135mm Aaa Stent Graft BOTH IP/OP "$25,471.00 " "$18,848.54" $0.00 "$20,376.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$19,633.05" $0.00 "$5,308.16" $0.00 $0.00 $0.00 $0.00 "$12,735.50" "$20,173.03" "$20,376.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202735 EAP Custom 27202735 22x13x135mm Aaa Stent Graft BOTH IP/OP "$25,471.00 " "$18,848.54" $0.00 "$20,376.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$19,633.05" $0.00 "$5,308.16" $0.00 $0.00 $0.00 $0.00 "$12,735.50" "$20,173.03" "$20,376.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202736 EAP Custom 27202736 24x14x135mm Aaa Stent Graft BOTH IP/OP "$25,471.00 " "$18,848.54" $0.00 "$20,376.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$19,633.05" $0.00 "$5,308.16" $0.00 $0.00 $0.00 $0.00 "$12,735.50" "$20,173.03" "$20,376.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202737 EAP Custom 27202737 26x15x135mm Aaa Stent Graft BOTH IP/OP "$25,471.00 " "$18,848.54" $0.00 "$20,376.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$19,633.05" $0.00 "$5,308.16" $0.00 $0.00 $0.00 $0.00 "$12,735.50" "$20,173.03" "$20,376.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 27202738 EAP Custom 27202738 28x16x135mm Aaa Stent Graft BOTH IP/OP "$25,471.00 " "$18,848.54" $0.00 "$20,376.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 "$4,181.12" "$4,181.12" "$19,633.05" $0.00 "$5,308.16" $0.00 $0.00 $0.00 $0.00 "$12,735.50" "$20,173.03" "$20,376.80" $0.00 $0.00 $0.00 $0.00 $0.00 $0.00